Comprehensive RCM Going beyond the standard medical billing to offer more customized value added services
Anion clients including PCPs, Specialists, IPAs, and ACOs are a happy lot. The reason is simple: their backend revenue-generating processes are run and maintained by experts at Anion, leaving them with peace of mind, time for core work, and concentration on patients for better treatment.
Our comprehensive RCM services have been repeatedly benefitting clients with:
Our services are offered either as an integrated package or as specific offerings against demand. The gamut of our RCM services is split as
We begin our services at the provider office with patient registration services (patient demographic info), and appointment fixation.
We handle the process of checking the insurance eligibility of the patient even before he/she visits on the appointed date. This will ensure if the patient is still eligible with the insurance we have for him on our records, the co-pay/deductible part, the co-insurance, and so on. This will help the front office to collect the patient cost share upright avoiding a lot of administrative costs, like sending paper bills and phone calls.
Our expert referrals team members
Our provider analytical software engine empowers us to keep a track of the patient and ensure follow-up with regards to any referrals and further course of treatment as driven by the primary PCP.
Based on the encounter form, charges are created under a claim and checked for the mapping between the CPTs and ICDs to make it ready for submission to insurance companies.
Billing-ready claims are submitted electronically through a clearinghouse to corresponding insurance companies. Clearinghouse sends the report of accepted/rejected claims. The team makes the necessary corrections and resubmits the claims. Claims which cannot go through electronically are sent via paper.
Upon submission of the claims to Insurance companies, based on the statutory claims processing turnaround time, EOB (Explanation of Benefits) is received. The payment is posted in the EMR based on the EOB and tallied to a penny.
In the EOB, along with payment, some denials are also expected. Our team is experienced to sort out and segregate the denials to find out the root cause. We ensure that necessary checks are put in place to avoid such cases subsequently.
Traditional Medicare payment based on the FFS approach has been changed of late. Payments/incentives will be based on the Hierarchical Condition Categories (diagnosis grouping model) based MRA (Medicare Risk Adjustment) score. This means doctors treating sick patients will be paid more compared to healthy patients as sick patients need more care/supervision. Our team is trained on ensuring that the right analysis is done and the best recommendations are provided to the doctors.
Of late due to new healthcare reforms, CMS came with many incentive programs like ‘meaningful use’, EHR, PQRI and so on which will bring decent remuneration into the practice as a bonus. We have good knowledge in setting up for these incentive programs.
The biggest challenge for Providers is the collection of Accounts Receivables (AR) because claims have filing limits and correcting mistakes through the first submission can be a lengthy process in some instances. Our team is well trained to handle these issues swiftly and with quick follow-up.
