Revmedi healthcare private limited empowers healthcare providers to focus on what matters most – their patients. Decades of experience and top-tier medical coding expertise ensure accurate claims processing, freeing you from administrative burdens. This allows you to dedicate more time to delivering exceptional patient care and improving the health of your community...….Solving the most complex revenue cycle challenges....our RCM services includes
Patient pre-authorization
Patient pre-authorization is a crucial step in healthcare administration, ensuring streamlined processes and proper utilization of resources.
Utilizing ICD-10 (International Classification of Diseases, 10th Revision) codes, pre-authorization verifies medical necessity for procedures and treatments.
CPT (Current Procedural Terminology) codes are also employed to identify specific services requested.
This process aids in determining coverage eligibility and preventing unnecessary costs for patients and healthcare providers.
Through efficient pre-authorization, Revmedi Healthcare Solutions optimizes patient care while adhering to regulatory standards.
By integrating technology and expertise, Revmedi ensures expedited pre-authorization, enhancing overall healthcare delivery.
Effective pre-authorization safeguards against billing discrepancies and promotes transparency in healthcare billing practices.
Revmedi's commitment to patient pre-authorization underscores its dedication to quality care and financial integrity in the healthcare industry.
Patient eligibility verification
ICD-10 Codes Integration: Utilizing the International Classification of Diseases, 10th Edition (ICD-10) codes, Revmedi ensures precise identification of diagnoses. This integration facilitates comprehensive understanding and validation of the patient's medical condition.
CPT Codes Application: Current Procedural Terminology (CPT) codes are instrumental in delineating medical procedures and services provided. Revmedi utilizes CPT codes to ascertain the appropriateness of treatments sought by patients, aligning them with their eligibility status.
Automated Verification Systems: Revmedi employs advanced automated systems that cross-reference patient information with ICD-10 and CPT codes databases. This expedites the verification process, reducing manual errors and enhancing operational efficiency.
Real-time Eligibility Checks: Through real-time integration with insurance databases, Revmedi conducts instantaneous eligibility checks. This ensures patients receive timely and accurate information regarding their coverage, minimizing billing disputes and improving patient satisfaction.
Compliance and Documentation: By adhering to regulatory standards and documenting each step of the verification process, Revmedi ensures compliance with healthcare laws and regulations, safeguarding patient privacy and maintaining data integrity.
Claims denial management
Advanced Coding Expertise: Revmedi employs certified coders proficient in ICD-10 and CPT coding systems. These experts meticulously review claims to ensure accurate code assignment, reducing the risk of denials due to coding errors.
Denial Analysis: Utilizing sophisticated analytics tools, Revmedi conducts thorough analysis of denied claims. By identifying patterns and trends, they pinpoint root causes of denials, enabling proactive resolution strategies.
Appeals Management: Revmedi's team specializes in crafting compelling appeals tailored to specific denial reasons. They leverage their in-depth understanding of coding guidelines and payer requirements to maximize appeal success rates.
Real-Time Reporting: Through intuitive reporting dashboards, clients gain real-time visibility into denial trends, appeal statuses, and revenue recovery metrics. This transparency empowers providers to make informed decisions and optimize their revenue cycle management strategies.
Continuous Improvement: Revmedi fosters a culture of continuous improvement, constantly refining processes to adapt to evolving coding regulations and payer policies. This proactive approach ensures sustained success in claims denial management.
Patient side of collection
ICD-10 Codes: These alphanumeric codes classify diseases, injuries, and medical conditions. Understanding these codes helps patients comprehend the reason behind certain charges on their bills. For instance, ICD-10 code Z00.00 indicates a routine health check-up, providing clarity to patients about the nature of the service they received.
CPT Codes: Current Procedural Terminology codes outline medical procedures and services provided by healthcare professionals. Patients should be informed about the CPT codes relevant to their treatment to grasp the associated costs. For instance, CPT code 99213 denotes a level 3 outpatient visit, enabling patients to understand the billing specifics.
Cost Estimation: Providing patients with cost estimates based on their insurance coverage and the services they require fosters transparency. Revmedi Healthcare Solutions emphasizes the importance of empowering patients with this information to facilitate informed decision-making regarding their healthcare.
Payment Options: Offering flexible payment options and financial assistance programs eases the burden on patients. Revmedi ensures that patients are aware of available avenues for managing their medical expenses, promoting financial wellness.
Provider credentialing
Credential Verification: The initial step involves verifying the credentials of healthcare providers, including qualifications, licenses, and training.
ICD-10 Integration: Integration of ICD-10 codes ensures accurate coding for diagnoses, facilitating streamlined patient care documentation.
CPT Code Utilization: Incorporating CPT codes enhances billing accuracy by precisely documenting medical procedures and services rendered by providers.
Quality Assurance: Provider credentialing ensures compliance with industry standards and regulatory requirements, fostering a culture of quality assurance within healthcare facilities.
Network Participation: Credentialing allows providers to participate in insurance networks, expanding access to care for patients and optimizing reimbursement processes.
Continuous Monitoring: Credentialing is an ongoing process, involving regular monitoring of provider performance and adherence to standards to uphold patient safety and satisfaction.
Efficiency Enhancement: By automating credentialing processes and integrating coding systems, Revmedi Healthcare Solutions enhances operational efficiency, reducing administrative burdens for healthcare providers.
Patient-Centric Care: Through robust credentialing practices, healthcare organizations prioritize patient-centric care delivery, promoting trust and confidence among patients.
EDI rejections
ICD-10 and CPT Code Discrepancies: EDI rejections often stem from inconsistencies between provided ICD-10 diagnosis codes and CPT procedure codes. RevMedi emphasizes meticulous coding practices to ensure accuracy.
Incomplete Patient Information: Missing or erroneous patient details trigger EDI rejections. Revmedi emphasizes thorough data entry protocols to include all necessary patient demographics and insurance information.
Authorization and Eligibility Issues: Failure to obtain prior authorizations or discrepancies in patient eligibility status result in EDI rejections. Revmedi advocates for proactive verification processes to prevent such denials.
Documentation Deficiencies: Inadequate documentation supporting medical necessity leads to EDI rejections. Revmedi encourages comprehensive documentation practices aligned with payer requirements.
EDI Protocol Compliance: Non-compliance with EDI formatting standards causes rejections. Revmedi ensures adherence to EDI protocols to facilitate seamless data transmission.
Payment posting
Utilizing ICD-10 and CPT Codes: We leverage the International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes to accurately categorize medical diagnoses and procedures. This ensures transparency and accuracy in payment posting.
Automated Systems Integration: Our integrated systems automatically match payments with corresponding patient accounts, eliminating manual errors and reducing processing time. This integration enables real-time updates and enhances overall efficiency.
Comprehensive Reconciliation: We meticulously reconcile payments against billed services, verifying accuracy and detecting discrepancies promptly. This thorough approach minimizes billing errors and prevents revenue loss.
Streamlined Workflow: By employing standardized workflows, we ensure consistency and effectiveness in payment posting procedures. This results in quicker turnaround times and improved cash flow management for healthcare providers.
Continuous Training and Development: Our staff undergoes regular training to stay updated on evolving billing regulations, coding guidelines, and industry best practices. This ensures compliance and enhances proficiency in payment posting processes.
Patient statements processing
Accurate Coding: Utilize ICD-10 codes to precisely identify diagnoses and CPT codes to capture medical procedures and services rendered during patient visits. Accurate coding lays the foundation for transparent billing.
Automated Systems: Implement automated billing systems that seamlessly integrate ICD-10 and CPT codes. These systems minimize errors and expedite the processing of patient statements.
Claim Scrubbing: Employ claim scrubbing software to identify discrepancies in coding before submission. This proactive approach reduces claim denials and accelerates reimbursement cycles.
Transparent Communication: Clearly communicate billing details to patients through itemized statements. Include ICD-10 and CPT codes alongside service descriptions to enhance transparency and alleviate patient concerns.
Education and Training: Provide ongoing education and training to administrative staff on proper coding practices. Ensuring staff competency in ICD-10 and CPT coding reduces errors and optimizes reimbursement.
Regular Audits: Conduct regular audits of coding practices to identify areas for improvement and compliance with industry standards.
AR management
ICD-10 and CPT Code Integration: Revmedi's AR management system seamlessly integrates with ICD-10 and CPT codes, ensuring accurate coding and billing. This integration minimizes errors and reduces the risk of claim denials, leading to faster reimbursements.
Real-Time Claim Tracking: With Revmedi's AR management platform, healthcare providers can track claims in real-time. This feature allows for proactive identification and resolution of billing discrepancies, leading to improved cash flow.
Automated Remittance Processing: Manual remittance processing can be time-consuming and prone to errors. Revmedi automates this process, reconciling payments with claims and identifying any discrepancies efficiently.
Customized Reporting: Understanding AR performance is vital for optimizing revenue cycles. Revmedi offers customizable reporting tools, allowing healthcare providers to analyze AR metrics and trends comprehensively.
Denial Management: AR management involves effective denial management strategies. Revmedi's solution includes robust denial management functionalities, identifying root causes of denials and implementing corrective actions promptly.
Patient Communication Integration: Clear communication with patients regarding their financial responsibilities is essential. Revmedi integrates patient communication tools within its AR management system, facilitating transparency and reducing payment delays.
Medical coding review
Precision in Billing: Medical coding serves as the bridge between patient care and reimbursement. Accurate coding not only prevents revenue loss due to underbilling but also mitigates the risk of audits stemming from overbilling.
Compliance Assurance: With ever-evolving healthcare regulations, compliance is non-negotiable. Regular coding reviews guarantee alignment with regulatory standards, minimizing the likelihood of penalties and legal issues.
Enhanced Revenue Cycle Management: Efficient coding directly impacts revenue cycle management, expediting reimbursement processes and optimizing cash flow for healthcare providers.
Quality Patient Care: Beyond financial implications, meticulous coding ensures that patients receive appropriate care based on documented diagnoses and procedures, fostering trust and satisfaction.
Risk Mitigation: Inaccurate coding can lead to claim denials, payment delays, and even reputational damage. Thorough reviews serve as a proactive measure against such risks.
Medical practice productivity review
1. ICD-10 and CPT Code Analysis:
Conducting a thorough analysis of ICD-10 and CPT codes used within the practice to ensure accurate coding and billing.
Identifying areas where coding discrepancies or inefficiencies may exist, leading to potential revenue loss or compliance issues.
2. Workflow Evaluation:
Assessing the workflow within the practice to identify bottlenecks or inefficiencies that may impede productivity.
Implementing strategies to streamline processes and improve operational efficiency, from patient scheduling to billing.
3. Provider Performance Review:
Evaluating individual provider performance based on coding accuracy, patient throughput, and documentation practices.
Offering targeted training and support to providers to enhance their coding proficiency and overall productivity.
4. Technology Integration:
Leveraging technology solutions to automate repetitive tasks, such as appointment reminders or insurance verification, freeing up staff time for more critical functions.
Integrating electronic health records (EHR) systems with billing software to ensure seamless documentation and billing processes.
5. Continuous Improvement:
Establishing ongoing monitoring and review processes to track productivity metrics and identify areas for further improvement.
Providing ongoing support and guidance to ensure sustained productivity gains and compliance with evolving regulatory requirements.
Patient billing inquiries support
Streamlined Communication: Revmedi facilitates efficient communication between patients and billing departments, ensuring clarity and accuracy in inquiries resolution.
ICD-10 Code Integration: By utilizing ICD-10 codes, Revmedi enhances the specificity and accuracy of billing inquiries, reducing errors and delays in processing claims.
CPT Code Implementation: Incorporating CPT codes allows for precise identification of medical procedures and services, enabling transparent billing explanations to patients.
Enhanced Patient Understanding: Revmedi empowers patients with clear explanations of billing statements, using CPT and ICD-10 codes to elucidate medical procedures and diagnoses.
Improved Reimbursement Rates: With accurate coding and detailed billing explanations, healthcare providers experience improved reimbursement rates, reducing revenue cycle inefficiencies.
Compliance Assurance: Revmedi ensures compliance with industry standards and regulations by adhering to established coding guidelines for ICD-10 and CPT codes.
Customized Support: Tailored solutions provided by Revmedi address specific patient needs, offering personalized assistance for billing inquiries and concerns.
Payer contract reviews
ICD-10 and CPT Code Analysis: Payer contract reviews delve deep into ICD-10 and CPT codes, meticulously scrutinizing contract terms against billing practices. By ensuring alignment between provided services and reimbursable codes, healthcare providers can maximize revenue while minimizing compliance risks.
Identification of Discrepancies: Through rigorous analysis, Revmedi identifies any discrepancies between negotiated contract terms and actual reimbursements. This meticulous scrutiny helps in uncovering underpayments, ensuring that healthcare providers receive fair compensation for their services.
Negotiation Leverage: Armed with comprehensive insights from contract reviews, healthcare providers gain substantial leverage in renegotiating terms with payers. Revmedi empowers clients to advocate for fairer reimbursement rates and improved contract terms, ultimately enhancing financial viability.
Enhanced Operational Efficiency: By streamlining contract management processes, Revmedi enables healthcare providers to focus on delivering quality care rather than grappling with administrative intricacies. Automated systems and tailored solutions expedite workflows, driving operational efficiency.
Continuous Monitoring and Adaptation: Payer landscapes are dynamic, requiring ongoing vigilance. Revmedi's proactive approach includes continuous monitoring of contract performance and timely adaptations to changing regulatory landscapes, ensuring sustained financial health for healthcare providers.
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