Revenue Cycle Management - Reporting Service - Medrelier Pvt Ltd.

Improve Your Collections and Accelerate Your Revenue Cycle

Eligibility Verification

Verifying patient’s current insurance coverage, whether any claims have been denied or delayed due to inadequate or incorrect information and whether payments are expedited at the appropriate rates.

Benefits Verification

Verification of deductible balances and the amount that has already been paid in the patient’s account.

Authorization

Following up with the insurance companies to ensure approval of medical services, prior to services being rendered.

Charge Posting

Verifying whether created patient records are assigned with the charges associated with the particular procedures, ensuring relevant checks at each processing stage.

Payment Posting

Processing a large amount of EOB’s & remittance paperwork, knowing the reasons for denials, prior-authorization, non-covered services, quality of your clinical documentation and coding processes, and effectiveness of your front-end patient collections.

The types of remittance transactions include:

Electronic Remittance Advisory (ERA) Posting.
Manual Payment Posting
Denial Posting
Posting Patient Payment

Denials Management

Verifying whether any negative determination was made by the payer and determining why the claim was denied to make a reconsideration request saving your time and money.

A/R Management

At Medrelier, we aggressively follow up with the insurance companies for denied claims and reopen them to receive maximum claims.

Our A/R Follow-up Process:

We identify and analyse the claims listed in A/R report that require follow-up.
These are then reviewed with provider’s policy to identify which claims requires to be settled off.
The team is then provided with analysed claim information to follow-up with the insurance company and determine the status of the claim.
All the details of the claims are gathered in one place and after completing the posting for payment details for outstanding claims, actions are taken for initiation of non-payments.

Demographics Verification

At Medrelier, our efforts are integrated towards accurately filing the necessary information of patient’s demographics and send it across to the payers ensuring high accuracy at lower costs.

Claims Management

Our solutions produce claims that result in full reimbursement, are compliant with Medicare and payers, integrate with Patient Accounting Systems (PAS), and provide visibility across the revenue cycle.

Reporting

Here are some of our Standard Reports:

Practice Financial Summary
Practice Score Card
Provider Scorecard
A/R Aging Analysis
Receivable Analysis

Based on the requirements of the client, customizable reports can be provided.

Credentialing

We help providers get credentialed by providing clarifications from payers and following them up to close the credentialing request.

Provider Credentialing:

Applying with necessary documents and figuring out exceptions.
Verifying the Primary Source Documents from physicians.
Updating payer’s database if there is any missing information.
Following up on submitted credentialing requests.
Update information as per policies and procedures.

Provider Enrolment:

Verifying provider information before submitting claims.
Confirming and updating provider’s billing address.
Enrolling for electronic transactions.
Validating and Monitoring the process.

Revenue Recovery

Our HIM experts have good understanding of the process and contract between payers & providers.
We interpret, analyze and identify systemic underpayments by payers at the individual claim level.
We do consistent, personalized, courteous follow-up on all accounts with outstanding balances.
We do have excellent AR follow-up skills to call upon payers, enquire about the correct reason for denial and work as per their clarification and getting the claim paid.
If an insurer routinely down-codes claims, we appeal for the code that was submitted originally and include supporting documentation.
If an insurer consistently refuses payment for a certain code, we request the physicians to contact the insurer, discuss the situation and bring along supporting documentation instead of sending more appeals.
Before signing any contract with a payer, we request the physicians to make sure that the claim appeal process is explained clearly. This helps us determine steps to be taken after a denial and consider steps for further action.