Revenue Cycle Management

Optometrists | Internal Medicine Doctors

Family Physicians | DME Providers

Billianz Revenue Management Services covers financial processes from registration and appointment scheduling to the final payment of a balances for Hospitals, Physicians, Clinics, Providers, and Healthcare Organizations. We help your practice collect every dollar you earn. With it, you can free up resources to focus on higher-value activities and reduce administrative costs.

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  • Maximize revenues
  • High process efficiency
  • Quicker turnaround time
  • Efficient client co-ordination
  • Eliminate 'Non-Medical' infrastructure expenses
  • Reduce record storage space
  • Receive detailed reports
  • Focus on patient care instead of billing

Eligibility Benefit Verification

Billianz authenticates the info provided at booking to verify eligibility and pre‐authorization for the appointment. This step helps to identify data entry errors or missing info. Using the billing info captured at booking, we contact the insurance carrier to determine eligibility and seek pre‐authorization for specific visits/providers. Besides simple insurance eligibility, we prepare the account for accurate billing, ensuring coverage is active at the time of service. This identifies the amount the patient is obligated to pay in the form of deductibles, co‐payments or co‐insurance.

Charge Entry

This involves capturing, entering, and editing (“scrubbing”) the information needed to create a medical billing claim (to an insurance company or payer). This includes “demographic” information about the patient including insurance coverage details and “charge” information: a combination of CPT and ICD-10 codes determined by the physician or a coder. Clinical care documentation should match coding and charge capture.

Claims Submission

Front end edits make sure that all information is accurate and consistent so that the claim will be accepted by the payer (insurance company). Claims are filed electronically using medical billing software and EDI technology or on paper. Most payers now accept electronic filing, but some smaller payers still require paper. What sets us apart is the fact that we follow claims until they reach the payer and continue our follow-up until the payer acknowledges the receipt of claims.

Clearing House Services

We work with your choice of an appropriate clearinghouse. Clearinghouse submits your manually-managed direct submissions and secure payments faster. It improves reimbursements on account of better controls and reporting tools that help you to verify eligibility, monitor rejections, report the reasons and fix submission errors with a few mouse clicks. In case of clearing-house rejections, we keep track of it on a daily basis and work on transmitting it instantaneously.

Payments Posting

The perfect blend of advanced technology, cost effective solutions and qualified billing professionals, we can get all payments posted in the billing system precisely. Clarus takes payment posting a step ahead by religiously following-through the process and accounting for denied claims. Our team is well-versed in posting 835 Electronic remittance advice (ERA).

Denial Management

Denials are edited and resubmitted within three business days of them being denied, turning them quickly into revenue for our clients. Where claims are denied, a timely response is required to overcome the objection and resubmit the claim for payment. Denials are frequently assigned to the most experienced billing experts, sometimes by payer, sometimes by reason (denial code), and usually by specialty for multi-specialty practices or billing companies.

AR Followup

Your payer and patient accounts receivables are diligently worked, keeping your number of days outstanding to a minimum. We track submitted claims to ensure receipt by payer and take appropriate action (modify, appeal or write‐off) in response to denials or partial payments. As claims and patient statements are outstanding, it is critical to monitor the payment intervals on "Days in A/R" basis. Well run practices and medical billing companies also analyze underpaid claims by comparing payments to contracted amounts and flagging exceptions. Follow-up on these situations is critical to achieving strong collections results.

Patient Statements

Patient balances typically include co-pays, deductibles, and other forms of “patient responsible” billing. Usually a statement is issued with payment expected within 30 days. Increasingly, credit card and other payment arrangements are expected. This is especially important for patients with so-called High Deductible Health Plans, where the patient due amount can be substantial.

Reports & Analytics

Reporting is an integral part of revenue cycle management, since it reflects the results and statistics about practice health, both financial health and operational health (e.g. productivity). Comprehensive financial and performance reports analyze business trends, activity, and measure and track your results over time. Analytics provide your practice with insight into business strategies that will help you move your practice forward and improve your financial performance.

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