Every claim your practice submits is the result of a long chain: scheduling, eligibility, paperwork, coding, submission, payer review and payment. If one link breaks, revenue lags or never comes. Health XRCM offers revenue cycle management services that take care of that entire chain so your clinical team can focus on patients while a dedicated billing team works to get claims paid appropriately and on time.
Our healthcare revenue cycle management systems cover the entire patient-to-payment experience, and are designed for clinics and medical groups that seek accuracy, visibility and reduced administrative work.
Healthcare revenue cycle management (RCM) is the financial process that follows a patient interaction, from the first appointment to the final payment. It connects the front office, clinical documentation, medical coding, billing and payer follow-up into a process.
Typical medical revenue cycle will include:
Health X RCM provides complete end to end revenue cycle management services so you don’t have to work with different providers for each stage.
To file a clean claim, you must have accurate demographic and insurance data. We check coverage and benefits before the visit, so eligibility issues are identified before becoming rejections.
The secret to certified-quality coding is detailed documentation. We examine the encounters and code what was documented and what the payers need using the ICD-10-CM, CPT and HCPCS with appropriate modifiers and linking to medical necessity.
Claims are reviewed for missing data, coding discrepancies and payer-specific requirements before submission. Electronic submission of clean claims assists in reducing needless denials and decreases the time to payment.
We post ERA and EOB payments and changes, compare to expected reimbursement and identify underpayments or contract deviations.
Denials are worked, not written off. We determine the root reason (eligibility, coding, authorization, timely filing or paperwork), correct and resubmit or appeal the claim, and feed the findings back into the workflow to prevent recurrence.
Aging claims are routinely followed up on with payers so that amounts do not stay in limbo. Higher value, older accounts get priority.
Good communication and prompt follow-up on patient balances helps with collections, while keeping the patient experience courteous.
You obtain insight into the key metrics: clean claim rate, denial rate, days in A/R, first pass resolution rate and net collection rate. These KPIs will show you where your revenue is bleeding and if your remedies are working.
Cardiology billing is complex for a good reason. Each practice has its own coding and payment standards and often combines office visits, in-office tests, imaging and treatments all into the same experience.
Our cardiology revenue cycle management help is focused on the areas where cardiology clinics lose revenue most often:
You can charge diagnostic services, such as echocardiography (CPT 93306), stress testing and nuclear cardiology (CPT 78452), globally or split using modifiers 26 and TC based on who owns the equipment and who interprets the research.
Same day office visit and diagnostic test (e.g. ECG, CPT 93000) may require modifier 25 and documentation to support a separately identified service. Interventional coding and cardiac catheterization Accurate documentation and careful consideration of bundle edits are needed for procedures.
Advanced cardiac imaging and procedures often require authorization and payers expect diagnosis codes to support the service.
Correct Coding Initiative changes and payer specific requirements impact what can be billed simultaneously. This creates a billing workflow that works like a real cardiology practice, not a generic one.
The difficulty is different than for solitary providers, says the report: More payers, more locations, more personnel turnover and more moving pieces. Our healthcare RCM services provide multi-provider organizations with a consistent procedure across the revenue cycle with reporting that shows performance by provider, payer and service line.
You need to hire, train, purchase software, and constantly update payer rules for an in-house billing department. Outsourcing your RCM management services might help you:
We analyze your present billing workflow, payer mix, rejection trends and A/R to identify revenue leakage.
We connect with your practice management system or EHR and agree on reporting, responsibilities and workflows.
We manage the above revenue cycle processes from eligibility to A/R follow up for you.
We share metrics for performance, and we use denial and payment trends to make the process better.
HIPAA compliance is a baseline, not a bonus, because revenue cycle work incorporates protected health information. Health XRCM handles patient data with privacy and security in mind and follows payer and regulatory requirements in daily billing operations.
It is the process of monitoring and controlling a patient’s financial activity with a provider, from appointment scheduling and insurance verification, all the way through to coding, billing, payment posting, and collection on unpaid claims.
Medical billing involves claim preparation and submission. RCM has a wider scope. It includes front-end activities like eligibility verification, coding, denial management, A/R follow-up, patient collections, and performance reporting.
They handle everything in the revenue cycle — from patient registration to final payment — under one team, so nothing gets lost in the shuffle between separate vendors or departments.
It facilitates appropriate coding of tests and treatments, correct use of modifiers, authorization tracking, and denial prevention, which are the areas where cardiology billing errors are most prominent.
Common measures include clean claim rate, denial rate, days in A/R, first-pass resolution rate, and net collection rate.
