Revenue Cycle Management Services

The revenue cycle involves everything from the initial interaction with a patient to the final insurance payment or direct payment from the patient. It begins with verifying insurance information and obtaining authorization for medical services. Then, during the treatment process, medical bills are generated and sent to payers or directly to patients. Next, insurance companies or patients review and potentially dispute charges before finally making payment to the practice.

This whole process is known in the healthcare industry as revenue cycle management and is crucial for practices to stay financially stable and provide continued care for their patients. Insurance companies and patient billing can be a complicated aspect of running a practice, but understanding and efficiently managing the revenue cycle is key to success. By working with the team of experts at NobilityRCM, you can ensure accurate and timely payments, allowing you to focus on providing top level care for your patients.

In the healthcare industry, revenue cycle management involves several steps, and generally begins the moment you interact with your patients. First, insurance verification is necessary to determine coverage and eligibility for a patient's medical claims. This process includes gathering all of your patient's information and using either technology or manual processes to verify that the coverage is accurate and up to date.

After your patients have had their appointment, the healthcare provider must correctly code and document services rendered during Patient Encounter. This allows for accurate claim submission, ultimately leading to insurance payment or patient responsibility collection.

We provide coding audits to ensure you are in compliance with all industry and payer regulations, but also to make sure your providers aren't under coding (resulting in lower payments). Following insurance payment, there may be claim denials or disputes that require appeal. We have a highly sophisticated claim scrubbing technology to make sure most claims get through cleanly on the first pass, but in the event that something comes back denied or rejected, our revenue cycle management team has the experience and know-how to make any necessary corrections. Finally, a continuous review process helps to improve efficiency in future healthcare revenue cycle management efforts.

Each step in the revenue cycle plays an important role in ensuring timely and accurate financial reimbursement for healthcare providers.

Outsourcing revenue cycle management can offer a number of benefits for healthcare providers and for your patients. By entrusting a specialized billing company like NobilityRCM to handle insurance claim submission and other financial tasks, staff can focus on providing high quality patient care while we ensure maximum reimbursement. Additionally, outsourcing allows for efficient processing of each and every claim, preventing costly errors and potentially increasing overall revenue. 

Outsourcing also allows for streamlined communication with insurance companies, ensuring that all necessary information is gathered in a timely manner. Overall, outsourcing revenue cycle management can improve the financial health of a healthcare practice and reduce staffing headaches, all while freeing up valuable resources to prioritize patient experience and satisfaction.  

One of the most common reasons for rcm denials that we see from our clients is missing or inaccurate information. This can range from missing patient demographics to incorrect codes being used for the services provided. We'll work hand in hand to make sure these types of denials are avoided using as much automation as possible. Another common denial reason is that the service rendered is not covered by the patients insurance plan. In some cases, this may be due to the service being deemed medically unnecessary. This can generally be avoided by doing a thorough eligibility check and determining whether a pre-authorization may be needed for a specific service.

Duplicate claims and claims that have already been processed can also result in denials. Finally, some insurance plans have limits on certain types of services, such as a limited number of physical therapy sessions per year. Being aware of these common denial reasons can help healthcare providers and billing departments ensure accurate claim submissions and minimize denials.

One of our main goals is to help each one of our clients experience minimal amounts of denials and rejections. We do this through a number of different approaches utilizing billing software (also known as practice management) technology, rules engines, and establishing best practices for your rev cycle. If you're looking for a revenue cycle management to help you cut back on the number of denials, don't hesitate to get in touch for a complimentary assessment and quote.