Our Services

Revenue Cycle Management

Revenue Cycle Management (RCM) is the process in which healthcare facilities and practices manage the entire billing lifecycle of the patient, from patient scheduling and registration to final payment and reconciliation in the finance accounts.

The Key front-end functions will dictate how quickly reimbursement is received and 50% of RCM activity is dependent on cashless authorization management. The remaining 25% RCM process include billing as per the rate agreed with respective payers while ensuring 95% adherence on the hospital billing protocols and 5% adherence on limiting disallowances during settlement time i.e. by accurately calculating non-medical amount at the time of final approval and discharge settlement. The rest of 25% in the RCM processes is entirely based on submission of claims/follow up /Managing Queries, ensuring settlement of claims as per TAT/Processing resettlements well as completing reconcilement of account receivables.

Patient registration and counselling — ensuring all demographic information is obtained correctly, e.g., insurance information, birth date, etc. and terms and conditions of credit issuance are explained  to the patient.

Eligibility verification — confirming a patient's insurance eligibility

Preauthorisation Registration

This refers to the collection of any outstanding patient information and consent required for the medical record in order to meet established clinical, financial, and regulatory demands. This is an opportunity to further engage patients, alert them to potential financial obligations, and better educate them about next steps in their care experience. A patient registrar can help identify alternative payers such as government entities or other liable third parties.

Treatment Budgeting

This refers to the process wherein the finance budgeting for the hospitalisation is done by the finance counselling team with the support of respective medical team. Budgeting as well the billing should be based on the agreed tariff (whether it be Open billing or Surgery packages) with the payer. Any deviation from the agreed tariff or package will lead to loss of revenue and payer objections or overbilling notification which can lead to suspension(or even black listing) of tie up by the insurer or TPA .

Preauthorisation Medical Review:

Medical details captured in the Pre-auth request form to be verified with patient medical records in the hospital as well as the previous treatment records-available if any. Partial or incorrect details pertaining to past history/comorbidities/chronic ailments etc, can lead to rejection of claim at the admission level or during claim settlement. Hence, preauthorisation medical review and discharge summary scrutiny is a vital part in RCM process and it decides the admissibility of the claim at any stage.

Discharge Bill Processing and Patient Settlement

Patient payables/Disallowance/Co Payments are to be collected during Cashless final approval and final settlement during discharge. Cashless process updation with patients at various levels - right from patient registration and counselling to final approval receipt - is an integral part of revenue cycle management as lack of communication with patients do affect patient experiences.

Account Receivables and Reconciliaton

Systematic recording of cashless claims, follow up and payment settlement with account reconciliation is the final step in RCM. Here the patient lability or insurance final approved amount should tally with the amount settled (including TDS), in case of any disallowance there, it should be managed with patient advance collected or else resettlement with insurer to be processed.

Claim Denial Management

Denial Management team at RCMassist is responsible for studying/analyzing denied claims as well as partially paid or underpaid claims. Denial Management team identify the denial reasons, they make corrections and resubmit the claims back to payers with Reconsideration or Appeal when required. Denial Management team constantly communicate with patients, healthcare service providers, and the insurance companies and take necessary actions based on their feedback or responses. The skills and quality of services delivered by the denial management team helps to determine the financial health of a healthcare providers.

When claims are kept pending for a certain amount of time due to additional information needed for the member. By following-up properly the denial management team can inform the member or provider about the situation and then a suitable action is taken so that the process for the payment is accelerated.

Credit Refund Management

Returning the money collected in excess as compared to fees charged for medical services rendered is the responsibility of the healthcare provider. While credit balances could happen on account of a variety of reasons, the top reasons are an over-payment from the payers and patient payments.

Failure to refund credit balances promptly could result in heavy legal costs, fines, and imprisonment. Hence it is vital that a dedicated team of experts processes your credit balances each month to avoid such situations.

Credit balances could provide an incorrect view of the financial health of the providers, and hence timely processing can give you the right view of your financial health.

Our team manages the refund process or recovery on a timely basis and ensure that the reconciliation is done completely in the finance module.

Reimbursement Management

Our team ensures that reimbursement claims are prepared in accordance with the policy terms and conditions, and return to the patients within 7 working days.