Front-End Revenue Cycle
- Patient Registration & Demographics Validation
- Insurance Eligibility & Benefits Verification
- Prior Authorizations & Referrals
- Financial Counseling & Patient Estimates
- Medical Necessity & Coverage Review
Coding & Charge Capture
- Charge Capture & Charge Entry
- Medical Coding (ICD-10, CPT, HCPCS)
- Behavioral Health & Facility Coding
- Coding Audits & Compliance Reviews
- Charge Reconciliation
Claims Management
- Claims Scrubbing & Editing
- Electronic & Paper Claim Submission
- Clearinghouse Management
- Claims Tracking & Status Follow-Up
- Timely Filing Monitoring
Payment Posting
- Electronic Remittance Advice (ERA) Posting
- Manual Payment Posting
- Patient Payment Processing
- Contractual Adjustments & Reconciliation
- Credit Balance Resolution
Denials & Appeals Management
- Denial Identification & Root Cause Analysis
- Underpayment & Overpayment Review
- Appeals, Reconsiderations & Disputes
- Medical Records Submission & Tracking
- Payer Correspondence Management
Accounts Receivable (A/R) Follow-Up
- Commercial, Managed Care & Government Payer Follow-Up
- Out-of-Network Claims Management
- A/R Aging Analysis
- Escalated Payer Negotiations
- Refund Requests & Rebuttals
Patient Billing & Collections
- Patient Statements & Invoicing
- Patient Payment Plans
- Self-Pay Collections
- Patient Appeals & Assistance Coordination
- Customer Service Support
Compliance & Quality Assurance
- HIPAA Compliance Oversight
- Documentation & Medical Record Audits
- Internal QA Reviews
- Payer Policy & Regulatory Monitoring
- Risk Mitigation Strategies
Reporting & Analytics
- KPI & Performance Dashboards
- Monthly Financial & A/R Reports
- Denial Trend & Payer Analysis
- Revenue Forecasting
- Custom Executive Reporting
Consulting & Advisory Services
- Revenue Cycle Assessments
- Workflow Optimization
- Payer Contract Analysis
- Fee Schedule Review
- Staff Training & Education
- Interim RCM Management