I’ve been there, done that, and have the rules to show for it.

Eligibility

I’ll make sure you’ve got updated demographic and insurance information from day 1.

Eligibility and benefits are tough to keep up to date on your own. I’ll maintain that data so you don’t end up with denials and invalid self pay accounts.

  • Demographic data updating
  • Eligibility confirmation with deductible balance
  • Insurance discovery for self pay accounts
  • Coordination of benefits account updating

Authorization

Put away the phone and the fax, I can handle your authorizations.

Authorization requires ensuring medical services are approved, and I can handle every step of the process.

  • Prior authorization requirement identification
  • Authorization submission
  • Supporting documentation submission
  • Phone follow up as needed by the RCM Ninjas

Coding

Coding is the root of a lot of problems, I’ll make sure to code accurately and never miss a charge.

Coding is a big task that involves translating information from patient records into the standardized codes used for billing, so let me and my team take it off your plate.

  • Immediate encounter notes retrieval
  • Diagnosis and charge audit
  • Follow up with missing physician signatures
  • Medical records review with help of the RCM Ninjas

Billing

Submitting claims that are going to be denied is half the problem, I’ll make sure that never happens.

Billing requires attention to detail and experts, and we have both of those, plus extensive experience dealing with insurance companies.

  • Insurance and demographic confirmation
  • Scrubbing codes against clinical rules
  • Scrubbing claim against payer rules
  • Fixing clearinghouse rejections with help of RCM Ninjas

Collections

Collections is not rocket science but it does require follow up, I’ll ensure every claim has a resolution.

Collections isn’t anyone’s favorite job, but it’s required in order for your practice to flourish, so let us take it off your plate.

  • Predictive payment dates
  • Automatic claim status
  • Supporting documentation submission
  • Phone follow up as needed by the RCM Ninjas

Denials

Denials should be prevented when possible, and responded to immediately always.

Underpayment is a much smaller issue when identified and handled immediately, which is why you need me.

  • Base fee schedule calculations at charge and claim level
  • Plan level carve out identification and maintenance
  • Crosswalking billed codes to response codes
  • Instant identification upon payment receipt

Underpayment

Know thy fee schedule and contract terms, or let me take care of that for you.

Underpayment is a much smaller issue when identified and handled immediately, which is why you need me.

  • Base fee schedule calculations at charge and claim level
  • Plan level carve out identification and maintenance
  • Crosswalking billed codes to response codes
  • Instant identification upon payment receipt

Posting

Posting and reconciling payments from payers and patients is filled with problems, but I can keep your books accurate.

Posting shouldn’t be a long, drawn out process when it can be instant.

  • Bank deposit log retrieval
  • 835 and EOB retrieval and extraction
  • Patient responsibility and prior payment auditing
  • Bot posting of reconciled payments

Analytics

When you ask ‘how are we doing’, you should expect answers with data and explanation.

Analytics are important for constant improvement, and I can give you the data you need.

  • Real-time reporting on data across systems
  • Financial health KPIs and benchmarking
  • Root cause identification
  • Productivity management

You don’t have to replace any legacy systems, just add BETH.

Learn More about RCM Brain's Capabilities