RCM services include Patient registration, Coding, Demographic and Charge entry, Charge entry, claims submission, EDI/Rejections, Payment posting, Denial management, AR follow-up, and Patient statements.

HelloMDs is an accredited provider offering a comprehensive range of services, including Credentialing and Enrollment, Billing, Prior Authorization, Accounts Receivable, Accounting, and Denial Management.

Indeed. Adhering to the set of laws and following industry standards not only saves healthcare practices from penalties but also creates transparency and a better environment.

In revenue cycle management, rejections and denials arise due to different reasons and are sorted out in different ways.

Claim Rejections: Errors or issues with the claim submissions result in claim rejections from the payers (insurance companies or entities that reimburse healthcare providers). Common reasons include Incomplete or Incorrect Information, Invalid Insurance Details, Incorrect Coding, or Format Issues. A rejected claim is typically flagged before it is reviewed or fully processed.
Solution: Since these rejections often arise before the final decision, they can be resolved quickly. Check out the errors and re-submit the claim swiftly.

Claim Denials: After the claim has been processed and adjudicated, payers may determine that the services provided are not covered, medically necessary, or do not meet specific policy requirements. This results in claim denials.
Solution: Appeals or resubmissions are required with supporting clinical documentation or a clear explanation of the medical necessity.

Definitely. The following easy steps shall help you measure your revenue cycle management performance:

First Pass Ratio: The percentage of claims that are paid by payers on the first submission without any rework or denials. A higher rate obviously indicates better performance.HelloMDs first pass ratio is 97%

Net Collection Rate: The percentage of the total expected revenue that is actually collected, after accounting for adjustments, write-offs, and contractual allowances.

Denial Rate: The percentage of claims denied by payers.

Average time consumed: The average number of days it takes to collect payments after services are rendered. The lower the number of days, the better the performance.
Collection costs: The total cost associated with collecting payments, including administrative, billing, and follow-up expenses. Monitoring this metric helps assess the efficiency and cost-effectiveness of your revenue cycle operations.

At HelloMDs, we have a team of specialists with years of revenue cycle management experience. Thus, choosing us can help you adhere to professional standards, minimize denials, increase your clean claims, and build a strong financial cycle of your medical practice.

Ensure that your claims are submitted timely and accurately, follow up regularly on outstanding claims, and consider using electronic claims submission for quicker processing.