1. Insurance Verification

   According to RMM, two of the top five claim denial reasons for Q3 2017 were insurance-coverage related. Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan in question.

   Putting a solid insurance verification process in place will reduce the coverage denials in your practice, which makes medical billing practices more efficient and raising your overall cash flow.

   Updating the billing system with most recent insurance information of patient details such as member ID, group ID coverage period, and co-pay information and other benefits information.

   In case of issues regarding a patient eligibility, we inform the front office immediately.

2. Eligibility & Benefits Check

   With the RMM, insurance and eligibility verification is absolutely critical. Identifying patient responsibility upfront prior to the visit is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created i.e. delayed in payments, reworks, decreased patient satisfaction, increased errors, and non-payment.

RMM offers credentialing and re-credentialing services. We offer these services whether you are a new practice starting or an established practice. Our credentialing services are performed by experienced individuals who have been in the medical field for over 20 years and were former medical office managers.

1. Individual Provider Credentialing
2. Group Enrolment
3. Individual Provider Linking to Group

1. Data Entry & Patient Demographics

   Following an appointment at the doctor’s office, we complete the Patient Demographic Entry by collecting and verifying the patient demographics received at the Patient visit. In the event that the patient is already registered in the medical billing system, new information is verified with the existing data and changes are swiftly updated.

2. Implementation models:

   Receive Patient information from front office and billing offices.

   Verify the patient’s insurance information.

   Enter Patient information in the billing system

3. Medical Record Documentation:

   It is important for the physician to record all medical services so the office can create an accurate medical bill to send to insurance providers or patients. This amounts to the patient's current balance. This information is given to the patient as a receipt. The patient can then check out.

4. Medical Coding:

   Our CPC, CCS, CMC, COC, CIC, CRC & AAPC certified Coders provide a Key step in the medical billing process, assigning appropriates codes by reviewing the documentation received from the Hospitals/ASC/physician’s office. We understand that medical coding is a vital process in medical billing. Proper coding is critical to reducing Insurance denials and increase revenue

5. Charge Posting

   Our Medical Billing professionals enter charges based on standard medical billing rules pertaining to each specialty, insurance carrier and the location. The charges are created within the agreed time frame -generally 24 hours Turnaround Time. Our charge entry team is well trained to work with numerous medical billing software, packages like Medisoft, Misys Tiger, AdvancedMd, Caretracker, ECW, Kareo, centricity, Athena, Praticsmax,

   Charges are entered into the client’s medical billing system based on account specific rules.

   The pending or held documents are sent to the front office for clarification, on a pre-determined schedule.

   The final charges are audited by the Quality team and the clean claims are filed.

1. Electronic and Paper Claim Submission

   A crucial step in the Medical Billing process is Claims transmission. The claims contain sensitive information including patient data and insurance information. Claims transmission through electronic submission reduces processing delays and ensures high readability.

   This guarantees that no claims are rejected due to illegibility. With electronic submission, the carrier confirmation report is also instant and prevents any time delays due to transmission. Tracking claims have also become easier and corrections can be made to the claims thus avoiding rejection.

2. Clearing House Rejections & Insurance Rejections:

   We provide Zirmed, Trizetto (Gateway), Emdeon & Availity - the leading Internet-based medical claims clearinghouse that helps physician/ Hospital practices increase profitability through improved claims reimbursement and staff productivity.

   We keep track on all the claims transmitted to insurance to make sure they reach the payor without any rejections. If found any EDI or Insurance rejection we resolve them at a high priority to fix the issue and re-transmit the claims.

• Payment Posting and Reconciliation

  At RMM, payments received from patients and insurance companies are posted to the patients’ accounts in the client’s billing system. The posted payments are balanced against the deposit slips to ensure accuracy in payment. We also process electronic posting of payments into the billing software and ensure that the EOB (Explanation of Benefits) files are stored for future reference.

  The payment posting team also checks for any underpayment being made to the accounts and move the accounts to the Accounts Receivable team for reprocessing.

• Denial Management

  Denial Management is critical in the process of medical billing. Our dedicated team of denial management experts execute a thorough analysis of the denied and underpaid claims to determine the reason behind the denial or underpayment.

  Corrective measures are taken on the basis of the analysis without any time delay, and the claims are re-submitted for acceptance of the insurance provider. After re-submission, the denial management team regularly follows up on the claims with the insurance provider to track status and expedites the payment.

• Accounts Receivable Management And Insurance Follow Up

  Collection of Funds- Receivables, is a challenging task. RMM employee’s has proven professional and efficient strategies to recover receivables and also excels in converting aged AR receivables into collections by effective follow-up with insurance providers.

• Appeal Process

  Integral to increasing client’s revenues, we spend much time and effort pursuing cases where a payment or denial has been made incorrectly, we challenge the insurance companies to receive the maximum reimbursement by submitting quality appeals to insurance at the first time.

• Correspondence

  Claims workflows are driven by correspondence, which represents most communications with insurance and provider regarding claim activity. Claims departments are among the most visible departments in billing company, and correspondence represents one of the most important customer touch points.

  We in RRM dedicated staff who are expert in reviewing and taking effective action on the each correspondence received.

• Secondary Insurance Billing:

  Billing patient secondary insurance is very important to collect complete eligible payment for patient and to make sure we are not leaving any revenue on table uncollected.

  In RMM we have dedicated experienced staff who works on secondary submission and AR collection.

• Patient Calling:

  A dedicated patient calling team follow-up with patients to get missing patient information by sending emails, notices or making phone calls and also we take incoming calls from patient to resolve the billing related inquiry.

Insurance companies may apply a portion of the allowed amount to patient responsibilities i.e. Co-Pay, Coinsurance, and Deductibles; Our billing professionals review accounts which have an outstanding balance after insurance payments, and print patient receipts in the client system.

As per the client’s requirements, we perform Small balance adjustments, Bad Debt Adjustments, Sending Discount Letters and Courtesy Adjustments.

Our Accounts Receivable management solutions also include the following optional services:

1. Handling of Refunds
2. Credit Balance
3. Handle Appeals for contested claims
4. Indexing of documents to the patient accounts
5. We work on LOP claims

Reporting is one of the great tool to track and show the time to time performance to client and management.

We in RMM provide the custom report as per the client requirement with the plans and implementation promising a great growth of the client and the company.