TO MAXIMIZE REVENUE, YOUR PRACTICE MUST DEPLOY OPTIMIZED REVENUE CYCLE PROCESSES.

From data capture at registration through collections, every step has to be Efficient, Effective and Timely. Revenue Cycle Management (RCM) solutions optimize existing technology and processes to reduce reliance on manual and error-prone processes so that your organization maximizes reimbursements.

Effective patient registration, insurance and benefits verification, charge capture, and claims processing are essential for a successful practice. iClaim will analyze whether current processes are followed adequately and efficiently. For instance, is claim adjudication taking too long, are claims being billed for the full amount, and are write-offs or adjustments too high. Also, iClaim will work on minimizing the denial as well as the rejection rate as our every practice has achieved a rejection rate of 1% or less and a denial rate of 2% or less. In addition, iClaim will monitor and control the number of days your claims remain in A/R and the percentage of your accounts receivable is more than 120 days.

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  Analyze the entire process and identify improvements.

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  Evaluate payer contracts and credentialing issues

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  Evaluate reimbursements

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  Use of proper documentation guidelines and appropriate coding levels.

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  Identify revenue losses by identifying potential coding issues

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  Provide a Code Audit for compliance by comparing AAPC, MGMA and CMS guidelines.

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  Payer Mix analysis by patient counts as well as claim counts.

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  Rejections and denial assessment.

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  AR Management

PATIENT REGISTRATION

The revenue cycle starts with patient registration. iClaim helps educate front desk in capturing the required information during patient registration. The front-desk staff should collect complete patient demographics and insurance information so that eligibility is verified. This process will help control rejections that are caused due to eligibility. As technology has advanced, eligibility verification’s have become very efficient as it has already been built into the most system (PM and/or EMR).

INSURANCE ELIGIBILITY VERIFICATION

Checking insurance eligibility verification is a very important step in the billing process as well as the revenue cycle management. iClaim’s job is to help practices to create proper and powerful workflow processes in terms of verifying eligibility information, handling of copays as well as handling past due balances and high deductible planning. It is very important to train the front desk to handle high deductible, and higher patient responsibility plans, in which iClaim excels in. If proper training and workflow are developed, collection rates will improve as well as patient satisfaction.

CHARGE CAPTURE

iClaim has worked with several different EMR systems and will help educate providers on how to eliminate the use of paper charts and directly document in EHR systems as to help with efficiency, avoid inconsistencies, lost data and redundant work practices. Furthermore, asking your front desk to compare electronic patient information against the paper encounter form is burdensome and creates more work and discrepancies. Transferring patient charges from the EHR to your practice management (PM) system should be seamless — electronically transmitting data is an example of an efficient workflow.

PAYMENT POSTING

iClaim routinely monitors payers, clearinghouse, and software vendors on any new services offered to and by them. We aggressively enroll every new payer on ERAs (electronic remittance advice). We recommend a lockbox service that deposits money into the bank for better cash flow as well as posting payments on time, which helps manage denials and account receivables. This speedy process ensures that the denials and follow ups are done in a timely manner. These days many insurance payers are putting timely filing limits on appeals, denial, progress notes, and initial submission. With a lockbox, iClaim and the client can routinely examine payment and possible billing issues.

REAL-TIME BILLING

Ideally, claims should be billed, within 3 business days between the dates of services and the claim date sent to the payer. This means providers will have to close charts within 48 hours of seeing the patients. It will assure proper checks and balances, and faster days to payment from dates of service. Patients will get statements on time and overall patient experience will be reflected in practice reviews. iClaim uses a clearinghouse to send patient statements, which is not only cost-effective, but statements get sent out in a timely manner, and the patients get to see a very professional, and precise documentation of the billing.