Anion's clientele, which includes Primary Care Physicians (PCPs), specialists, Independent Practice Associations (IPAs), and Accountable Care Organizations (ACOs), consistently expresses high levels of satisfaction. The reason is clear: our expert team at Anion efficiently manages and maintains their backend revenue-generating processes, allowing providers to focus on their core responsibilities and enhance patient care.
Our comprehensive revenue cycle management (RCM) services have proven to deliver significant benefits, including:
Optimizing revenue flow and accelerating cash realization.
Reducing claim denials through meticulous oversight and proactive management.
The breadth of our RCM services encompasses a wide range of offerings, designed to enhance efficiency and support the financial health of healthcare organizations. The gamut of our RCM services is split as:
At Anion, our revenue services are meticulously designed to enhance the efficiency and effectiveness of the revenue cycle management (RCM) process, ensuring optimal financial performance for healthcare providers.
We facilitate a seamless appointment process, ensuring that patient information is accurately recorded and managed from the outset.
Prior to the patient’s visit, we conduct thorough insurance eligibility checks to confirm coverage. This proactive approach verifies the patient’s eligibility, outlines any co-pays, deductibles, and co-insurance responsibilities. By equipping the front office with this crucial information, we help streamline the collection of patient cost shares, significantly reducing administrative expenses associated with billing and follow-up communications.
Our dedicated referrals team ensures that all authorization requests are handled with precision and urgency. Key services include:
Leveraging our advanced provider analytical software, we maintain a comprehensive tracking system for patient follow-ups, ensuring that all referrals and subsequent treatment plans are monitored closely, guided by the primary care physician (PCP). This integrated approach not only enhances patient care but also optimizes the overall efficiency of the revenue cycle management process.
We initiate the charge entry process by meticulously creating charges based on the encounter form. Each charge is carefully mapped between Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes, ensuring readiness for submission to insurance companies.
Billing-ready claims are submitted electronically through a clearinghouse to the appropriate insurance carriers. Our team receives detailed reports on accepted and rejected claims from the clearinghouse, allowing for prompt corrections and resubmissions as needed. Claims that cannot be processed electronically are submitted via paper, ensuring comprehensive coverage.
Following claim submission, we adhere to the statutory claims processing turnaround times to receive Explanations of Benefits (EOBs). Payments are accurately posted in the Electronic Medical Record (EMR) system, meticulously reconciling each transaction to the penny based on the EOB details.
Denials can occur alongside payments in EOBs. Our experienced team is adept at analyzing and categorizing these denials to identify root causes. We implement essential checks to mitigate future occurrences, ensuring a proactive approach to denial management.
With the evolution of Medicare payment models, traditional Fee-for-Service (FFS) approaches have transitioned to a focus on Hierarchical Condition Categories (HCC) and Medicare Risk Adjustment (MRA) scores. Our trained specialists provide in-depth analysis to ensure accurate documentation and coding, enabling physicians to receive appropriate compensation for the care of complex patients who require additional resources and supervision.
In response to recent healthcare reforms, the Centers for Medicare & Medicaid Services (CMS) have introduced various incentive programs, including meaningful use, Electronic Health Records (EHR), and the Physician Quality Reporting Initiative (PQRI). Our knowledgeable team assists providers in navigating these programs to maximize potential bonuses and enhance practice revenue.
Managing Accounts Receivable (AR) poses significant challenges for providers due to filing limits and the complexities involved in correcting submission errors. Our dedicated team is skilled in swiftly addressing these challenges, ensuring prompt follow-up and resolution to optimize cash flow and reduce outstanding balances. By employing a comprehensive suite of revenue services, Anion empowers healthcare providers to achieve greater financial stability and operational efficiency within the evolving landscape of U.S. healthcare.