Back-end Revenue Cycle Services

RCM services

Ensure Accurate and Timely Reimbursement: Minimize Revenue Leakage and Maximize Profitability.

Effective Back-end revenue cycle services are critical to improving the financial performance of the healthcare organization. But it requires a significant amount of time and effort that could be better spent on patient care. High Care provides technology-enabled services with a strategic approach that ensures a reduction in denials, reduced A/R days, and more accurate and timely reimbursement. Our team of billing specialists stays up-to-date with industry regulations and payer requirements in order to provide high-quality services that enable organizations to minimize compliance risk and improve the bottom line.

At High Care, our seasoned team of claim submission specialists submits clean claims (electronic or paper) to payers to achieve a higher first-pass rate. Our complete and accurate claim submission process helps your organization to get faster reimbursements and prevent denials. Our dedicated and diligent team of experts is always staying on top of the constantly changing payer processing rules to provide high-quality services.

Claim Submission Services:

  • Review the claims before submitting them to the payers. We utilize the functionality available in the practice management system to perform claim scrubbing.
  • Identify and correct the incomplete or incorrect data to ensure the claims are error-free.
  • Our experts are submitting clean claims to the payers and follow up with them until the claims are received.
  • Track and report the EDI responses and resolve any clearing house rejections.

Benefits of our services:

  • Increase clean claims rate
  • Faster and maximum reimbursement
  • Reduce denials and rejections
  • Fast turnaround time
  • Improve A/R cycle

A well-defined Payment Posting process can give a critical insight into the overall effectiveness of your revenue cycle management (RCM). An ineffective process of Payment Posting can lead to errors, resulting in poor cashflow and an increased A/R cycle. At High Care, a team of well experienced and certified coding and billing experts posts payments into the respective patient accounts with a quick turnaround time and high level of accuracy.

Our reliable and best-in-class Payment Posting services help you get a clear understanding on trends and reasons of denials, quality of coding process, non-covered services, and effectiveness of front-end patient collections. Our streamlined and systematic process provides a clear view of the efficacy of collections and reimbursements.

Payment Posting Services:

  • We receive a large volume of Electronic Remittance Advice (ERA) files from payers, which we process in batches by importing them into our client’s practice management system and making corrections to any exceptions using the functionality available on the system.
  • Manually posting the payments to the respective patient accounts from scanned images of Explanation of Benefits (EOBs). We adhere to the client-specific business rules for adjustments, write-offs and balance transfers to the patients or secondary insurers.
  • Our trained experts have complete knowledge of ANSI codes and payer-specific denial codes of different payers. We post each denial in the revenue cycle system and take necessary actions to re-bill to the secondary insurers, transfer balance to the patients, adjustments
    and write-offs and direct the claims to appropriate teams.
  • We post patient payments made via cash/check/credit card into the patient accounts in order to prevent increased A/R. Our staff transfer outstanding balances to secondary insurer and return money back to the patients for the overpayments.
  • Finally, we reconcilethe payment posting to actual deposits to ensure they match.

Benefits of our services:

  • Provide critical insights into the A/R trends.
  • Get a clear view of state of your revenue cycle.
  • Improve productivity and accuracy of payment posting services.
  • Help to develop policies for write-offs and adjustments.
  • Quick turnaround time.

Credit balance is a financial liability of the healthcare organization that should be managed with additional care and effort to remain in regulatory compliance and improve patient satisfaction. Overpayments from payers and excess payments from patients are the causes of credit balances. Ineffective management of credit balances can lead to an incorrect view of the financial health of the provider and may result in litigation and fines. Leverage High Care’s transparent and reliable Credit Balance services to identify the root cause of errors and resolve credit balances in a timely manner.

Our experienced and highly skilled team of credit balance analysts is dedicated to maintaining the financial stability of your organization.

Credit Balance Services:

  • Review account transactions, EOBs/ERAs to identify errors and thoroughly analyse credit balances.
  • Promptly refund the payers or patients for any incorrect adjustments or overpayments.
  • We prioritize the refunds of government payers. Refunds should be processed within 60 days from the date of the request for them. We process refunds for valid requests. If request is invalid, we raise an appeal after thorough validation.
  • Prepare and send the refund letter to insurance/patient with relevant documentations.
  • Effectively correct any adjustments or payments to improve the handling of patient self-pay transfers or secondary insurance billing.

Benefits of our Services:

  • Enhance relationships with patients and payers by providing timely refunds.
  • Minimize the risk of non-compliance, litigation and penalties.
  • Improve the reputation of your organization through the standard credit balance process.
  • Provide an accurate view of the A/R cycle

Well-organized Denial Management is one of the most important processes for
the financial success of healthcare organizations. However, managing denials can be a labour-
intensive and time-consuming process that diverts the focus of healthcare providers from providing
high-quality patient care. High Care can help you. Our team of experts’ systematic approach to the
denial management process helps to perform root cause analysis of denials, prevent future denials,
and improve reimbursement. We implement modern technologies and strategies to streamline the
denial management process.
Our experienced team of experts stays current on the latest policies and
procedures of insurers, while also adhering to National and Local coverage determinations and
government regulations to ensure the highest quality services.

Denial Management Services:

  • Categorize denials by type and reason and direct them to the appropriate department in order to simplify the process.
  • Identify and perform the root cause analysis of denials. Prioritize claims based on payer, age of the bill, amount, and other factors to maximize the benefits.
  • Analyse the denial reasons and take corrective actions. Prepare an appeal letter with a payer-specific format to appeal denials. Resubmit the corrected claims with supporting documentation to the insurance companies to reprocess the claims. And follow up with them until
    the claim is resolved.
  • Track and report denial trends and patterns to clients. Therefore, they can take preventive actions and reduce the denials.

Benefits of Services:

  • Improve cash flow.
  • Reduce claim denials through successful resubmission.
  • Access to experienced and skilled resources.
  • Reduce A/R cycle.
  • Staying current with industry regulations.

Learn how your organization can leverage our Back-end Revenue Cycle Services.