RCM HEALTHCARE SOLUTIONS, PLLC
Your Success Begins with Us
Payer credentialing and contracting services
RCM Healthcare Solutions provides payer credentialing and contracting services to help our billing clients prevail in today’s complex health insurance market. We understand if your other practice demands have not allowed the time to review each payer contract thoroughly or that you may not have reviewed your payer contracts in several years.
Payer credentialing for new practices
If you’re a new practice, we’ll take you through the required payer contracting and credentialing process from start to finish, including:
Completion of both payer and hospital credentialing applications
Contract review to ensure language is appropriate and all CPT codes for provided services are included in your contracted fee schedule to ensure your financial success.
Payer fee negotiation to obtain the highest reimbursement in your market when possible with detailed CPT / HCPCS fee analyses for provider / facility approval and execution.
Complete ERA and required EDI enrollment per payer.
Payer Credentialing and contracting for existing practices
If you’re an existing practice, we will:
Review and perform a complete financial market analysis of your existing payer contracts. If you do not have copies of your existing payer contracts, we will obtain executed copies on your behalf
Review existing contracts for opportunities to renegotiate and present our recommendations for execution
Complete both payer credentialing and recredentialing
Complete EFT, ERA and required EDI enrollment per payer
Maintain provider/facility credentialing documents and track renewal dates
Perform follow-ups to make sure payer participation is achieved in a timely manner
Provide well-established contracting processes that secure our billing clients the highest reimbursement and provide detailed line-item fee analyses for provider/facility final approval and execution.
We process your charges every day for the services rendered.
In this step, we provide:
Data Entry
Daily charges reviewed by the client are accessed and pulled via VPN access or exported via HL7 inbound interfaces directly from your EHR platform. Our data entry turnaround is two business days from the business day received.
Electronic and Paper Claim Submissions:
We ensure required EDI enrollments are completed during the go-live process to allow for daily electronic claim submission, which expedites claim adjudication and minimizes paper claims.
Line-Item Payment Posting
Each CPT®/HCPS code is one line item and payments are posted per line item. Since your top payer fee schedules are loaded into the billing system, we can identify and investigate inaccurate payments. This process can quickly identify contracted payers’ inaccurate payments.
Claim Scrubber
All claims go through the claims scrubber to identify coding and front-end edits for quick resolution. Our A/R staff reviews these edits daily.
Accounts Receivable Management
We serve as your full-service A/R department. To keep your A/R at or below industry standards, we involve our top-level medical and radiation oncology billing experts, including the company owners. We’ll also schedule standing monthly conference calls with you and your team to discuss outstanding A/R, payer issues encountered, charges, and receipts so that you have a mastery of your financial health and can be informed and involved in any necessary root cause resolution actions. Set up monthly calls with you and your team to discuss A/R, charges, and receipts so that you have a mastery of your financial health. At this time, you will be informed of payer issues and trends for your involvement in any necessary root cause corrections.
Appeal and Follow up on Accounts Receivable
Payer denials can occur for both accurate and inaccurate reasons. Our billing experts tackle the payer appeals process without hesitation. No matter where your practice is located, we’re abreast of payer policies, guidelines, and behaviors. We obtain all applicable medical record documentation from your EHR to support patient-specific medical necessity for the payer appeal submission in an effort for the initial payer denial to be overturned. In the event that the payer does not overturn the initial denial, our billing experts will exhaust all levels of appeal that are available in an attempt to overturn the payer denial.
Patient Services
Our patient services team is available Monday-Friday, 9:30am – 6pm PST to assist patients with billing questions, obtain credit card payments from patients, and/or establishing an agreeable monthly payment plan.
Patient statements are processed daily on a 30-day cycle and include a toll-free number for patients to contact our patient service team.
Financial Reporting & KPI Tracking
Weekly and Monthly Financial Report
Access your reports via a secured Citrix Share File account specific to each client with a dedicated login for each of your designated team. This is a client-specific and secure portal.
Around-the-Clock Reporting Access
Weekly and monthly financial reports are available to you and your team 24/7 allowing you to download and maintain the reports for future reference. These reports will be available in your client portal for a rolling 12 months.
Clear, Concise Weekly and Monthly Reports
Your weekly financial reports are available each week and your monthly financial reporting package is available by the 10th business day of every month. Upon request, we can provide custom financial reports.
Compliance and Medical Record Review
An annual medical record review will be scheduled to take place remotely or onsite.
We’ll conduct a comprehensive three-point evaluation of documentation, diagnosis coding, and procedure coding.
Upon completion of the review, a formal report will be compiled of all items reviewed to include actions necessary to ensure compliance.
A formal meeting will be scheduled to take place remotely or onsite to review report details.
Additional training can be provided upon client approval.
We are Audited to Ensure Accuracy for Our Internal Policies and Procedures
Each year we undergo an extensive SSAE 18 SOC 1 TYPE 2 audit by an independent third-party auditing firm that verifies how our systems, policies, and processes address each transaction. This year, we once again passed with flying colors – no exceptions or findings.
Why does this matter to you?
Well, it means that your practice is in good hands. It also means that you can trust our commitment to compliance and are indeed experts in the area.
In addition, pursuant to our corporate compliance plan, a thorough risk assessment is performed annually by an independent third-party firm to ensure HIPAA compliance and obtain certification of our compliance.
