RCM Healthcare Solutions, PLLC  

• We provide ongoing productivity and quality standard of 99% accuracy rate or better.

• Review the overall revenue cycle management billing which includes patient registration, eligibility verification, referral coordination, denials management, capitated accounts review, payment analysis, correct claims management, 1st and/or 2nd level of appeals, reconsiderations, disputes and credit refund analysis.

•  We provide timely claims submittals and expedited follow up that will implement processes to improve efficiencies.

• Meet established benchmarks and expectations for collections, aged accounts receivable balances, and days in AR. Resolve retro authorizations & Appeals.

• Run monthly accounts receivable reports, analyze outcomes, identify trends, and communicate with team on goals and objectives.

• Stay abreast of coding compliance and notify providers when coding changes are required.

• We adhere to payer contract agreements, payment posting accuracy, credentialing and recredentialing providers, audit reimbursement rates and fee schedules.

• Our qualifications include comprehensive inpatient and outpatient medical coding and billing experience with multiple specialties such as Speech, Physical, Occupational Therapy, Psychology, DME Medical Supply, Emergency Services, Dermatology, Cardiology, General Surgery, Orthopedic, Neurology, Family Practice, Internal Medicine, Gastroenterology, Obstetrics and Gynecology, Internal Medicine, Otolaryngology, Podiatry, Oncology, Transplants, Surgical Centers and many more.

• We work with the following provider types such as Ambulatory Surgery Centers, Ambulance Services, Clinical Labs, Hospital, Durable Medical Equipment, Home Health Agencies, Hospice, Private Physician Practices, Extended Care Facility, Resident, Clinics, Therapist, Radiology, Behavioral Health, Adult Day Care, Skilled Nursing, Drug & Alcohol Abuse Facilities and many more.

• We abide by the standards of Ethical Coding as set forth by the AHIMA and adheres to all official coding guidelines.

• Extensive knowledge of CPT, HCPCS, ICD 9-10-CM codes, regional and national payers such as Medicare, Medicare Advantage, Medi-Cal or Medicaid if out of state, HMO/PPO/EPO, Commercial, Worker’s Compensation, Liens, Self-Pay, Private Pay, Automobile Insurance and many more.  

•  Proficient in the Billing & EHR systems such as Athena, E-Clinical Works, Epic, Allscripts, Advanced MD, NextGen, Medical Manager, Cerner, Waystar, Cycare, Meditouch, Medisoft, Meditech, Kareo, Office Ally, Zirmed, Navicure, InVision, WIN OMS, EZ-Claim, TriZetto, Soarian Cerner, QuickBooks, DrChrono, Simple Practice, Practice Suite, Practice Fusion, Ability Network, XIFIN, SQL and many more.