Revenue Cycle Management

Revenue Cycle Management Services

Revenue Cycle Management (RCM) is one of the most necessary procedures in today’s healthcare environment. Hospital groups and physicians facing many challenges with their administrative work due to the shortage of skill sets and domain expertise resulting in outstanding revenues and chaotic revenue cycle management.

UCGS dedicated and experienced Professionals deliver best in industry services with great quality, highly accurate in timely manner which helps you to increase efficiencies and outcomes, reduce costs and risk, exceed patient expectations and deliver competitive services cost-effective. We manage the entire revenue cycle starting from a patient’s admission to the hospital, treatment and discharge, to post-discharge claims and accounts settling. With our help you can benefit from accelerated cash flow, structured and organized operations, faster revenue realization, and constant monitoring of key revenue cycles.

We make outsourcing simple and the transition to working with our team a quick and easy one. Our streamlined medical billing processes are designed to put our workforce at your finger tips as soon as we get started. We see our staff as an extension of your team.

Our comprehensive range of revenue cycle management services for the healthcare industry include:

PATIENT SCHEDULING AND APPOINTMENT

Scheduling of patient’s appointment through the provider’s online portal thereby streamlining the pre-registration process.
Collection of patient’s demographics for eligibility and prior authorization requirements.
Fixing the schedule based on the provider’s availability & directly communicating with physician and patients.
Informing the patient about the appointment and seeking for confirmation.
Convenient access to daily appointments with detailed information and sending automated reminders to the patient and provider email, phone and patient portal.

PRE CERTIFICATION / PRE AUTHORIZATION

Pre-authorization/ Pre-certification is mandatory for most private/ commercial health plans.
The documentation requirements vary by payer. We prepare prior authorization requests in payer-specific formats.
Once we receive Patient Identification details, Our trained specialists contact insurance and send across all clinical documentation to get initial authorization to start care.
Follow-up on submitted requests in timely manner and notify client for any issue with the authorization request.
We ensure our clients can deliver their core services to the patient without any fear of non-payment.

ELIGIBILITY & BENEFITS VERIFICATION

Verify coverage with Primary, Secondary and if applicable for Tertiary payers by utilizing payer websites and IVR systems. Information with regards to Non Participating providers, Non Covered services, Deductible limit, Copay /Coinsurance is provided to the Doctor’s office.
As required, we make calls to payers to check the eligibility status and patients for additional information
Update the results on the practice management system – update member ID, group ID, coverage start and dates, copay information and much more
We also provide additional services such as reminding the patient of the POS collection required, obtaining referrals from Primary Care Physicians (PCPs)

MEDICAL CODING

Our medical coding team is seasoned and expert in ICD, CPT & HCPCS Coding which is done in accordance with NCCI (National Correct Coding Initiatives) and LCD (Local Coverage Determination).

Access Patient Medical Records through secured network using VPN Connections.
Coders review and scrutiny the documents for accuracy and split them into batches for processing.
Diagnosis, Procedure codes and modifiers are assigned as per the coding guidelines and per client requirements.
Quality checks are in place prior to the charge Entry Process
We provide continuous feedback to our client with regard to the changes in the in codes and its selections that affects reimbursements.

CHARGE POSTING

We follow an accurate process of scrubbing claims during the charge posting process oriented towards maximizing first-time payments from insurers and minimizing denials.
We pre-define account specific rules in charge posting for different medical specialties which reduces the room for errors and contributes to clean claims.
Import charges directly from the EMR. These charges are reviewed for accuracy before being sent for billing.
Ensure the accurate Type of Bill, Revenue codes, authorization, patient status and episode of care are updated and submitted to the carrier.

CLAIMS GENERATION & SUBMISSION

A very important and crucial process in RCM is the claims submission.

UCGS billing solutions provides clean and error-free claims to the payers. This service includes both electronic and paper claims.
Our team of professionals identify and rectify the issues prior to the submission as a pre-check which ensures clean claims submission. This pre-check submission scrubs down the denials and fasten the collections.
Paper claims submission is done with care and are submitted with the relevant documents requested by the payers. Secondary claims with primary EOB and Primary claims with medical records are included in the Claims submission.
Any potential errors resulting from the transmission either at the gateway or at the insurance clearinghouse will be resolved and resent within 24 hours barring clinical discrepancies.

PAYMENT POSTING

We post payments received in all forms i.e. EOBs, EFTs received from carriers, banks, credit cards and cash payments.

Payments received from patients and insurance companies are posted to the patients’ accounts in the client’s medical billing system.
For payers who do not have Electronic Remittance (ERA), our team manually posts the payments into the patient’s account matching the allowed amount for each charge.
We ensure that all payments received are posted, we compare bank deposits with the total payment posted in the Practice Management System (PMS).
If the patient has co-insurance, the remaining unpaid charges will be filed to the secondary insurance as per the coordination of benefits.
Any deductibles, co-pays, Out-of-Pocket, and other patient responsibility stated by the insurance will be billed to the patient when the statements are generated.

DENIALS MANAGEMENT SERVICES

Denial management is a critical element to a healthy cash flow, and successful revenue cycle management.

Our dedicated denial management experts execute a thorough analysis of denied and underpaid claims to determine the reason behind the denial or underpayment.
Corrective measures are taken on the basis of the analysis without any time delay, and the claims are re-submitted for acceptance by the insurance provider.
After re-submission, the denial management team regularly follows up on the claims with the insurance provider to track status and expedite the payment

ACCOUNT RECEIVEABLE (A/R) Management

Our Accounts Receivable team compares expected and actual collections, understands the cause for discrepancies, and takes corrective measures to recover the difference.
Our systematic and regulated processes during each phase of the revenue cycle allow our AR team to keep Days in AR to below 30
An initial analysis of old outstanding receivables will be performed whenever a new client joins UCGS, and corrective action will be taken to recover as much revenue as possible from claims filed prior to the client joining UCGS (U-Connect Global Service)
Unpaid claims are processed using a prioritization based method, with high value claims and claims approaching the insurance timely filing limits given top priority
Any underpayment in the contracted amount or reimbursement rate of the insurance company will also be flagged and corrective action undertaken

PATIENT FOLLOW-UPS

We ensures patient statements are generated and mailed depending on the Patient Billing Cycle. The statements are constantly being sent out on a planned cycle thus creating a continuous flow of Revenue.
Easy to use patient portal to keep the patients connected at all times.
Follow up on your behalf for outstanding payments to reduce bad debts and maintain better relations.

PROVIDER CREDENTIALING & ENROLLMENTS SERVICES

PROVIDER CREDENTIALING

Our team of expertise complete required documentation, collects and verifies practitioner/ facility information from physicians which required within the Credentialing process.
Follow-up on submitted credentialing requests, obtaining capture data, label, link images, missing documents and update it to specific providers/facilities payer’s database.
Credentialing services for all the federal & commercial payers including MCR, MCD, Tricare, BWC.

PROVIDER ENROLLMENT

- Before claims submission we ensure that payers have the correct provider Information.
- We validate and update the provider’s pay to address or the billing address.
- UCGS highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

CREDIT & COLLECTION SERVICES

Our team will analyze each claim, identify the potential opportunities for cash, post refunds, make account level corrections to consistently maintain the overall integrity of your revenue cycle.
Audit the claims in the system with supporting EOB’s and ERA’s
Indentify incorrect/under paid claims and re-bill with supporting documents
UCGS credit balance review services ensure regulatory compliance while protecting revenue and streamlining operational workflow.

REVENUE RECOVERY

Auditing / Compliance

Access medical records for completeness and accuracy
Access documentation accuracy
Access compliance with respect to coding and billing
Enhance revenue
Discover lost revenue
Look for coding irregularities

Medical Billing Analysis

Review of entire billing process, including software
Coding practices and billing methodology
Unbilled charges and services
AR characteristics and type of denials
Revenue flow and A/R recovery
Dead AR recovery
Ageing review

Coding Analysis

ICD-10, CPT-4 and HCPCS coding
Modifiers usage
Under-coding E/M visits or vice versa
CCI and NCCI Edits
Accurate, ethical and compliant coding

Collection Analysis

Contracted amount vs. payment collected
Drugs P&L Analysis
Underpaid and undervalued charges
Contract negotiation
Out of Network payment analysis and negotiation

We are a dynamic and adaptable team of business solutions experts. With close to a decade of practical outsourcing knowledge and hands-on experience, U-CGS brings valuable expertise to the table.