Operations

Revenue Cycle Management (RCM)

We are aware of the pressures providers face to improve outcomes while simultaneously reducing costs, in the face of declining reimbursements and increasing challenges. We know that maximizing revenue cycle efficiency and improving billing, coding and reducing account receivables are of paramount importance to maintaining profitability and financial stability for practices and their owners.

We can help you manage your most important KPI of A/R Days and cycle times by providing comprehensive end-to-end services to cover all aspects of RCM including eligibility, code verification, charge entry, payment posting, secondaries, patient statements, denial management and managing Account Receivables.

OUR SUITE OF REVENUE CYCLE MANAGEMENT (RCM) SERVICES INCLUDE:

Eligibility Verification and Pre-authorization

We provide complete eligibility verification and pre-authorization services (for procedures and drugs), co-pay / co-insurance estimation.

Medical Coding

Our experienced coders are familiar with ICD 10 and CPT and validate procedure codes. Our teams also scrub procedure and diagnosis codes against correct coding initiatives and payer-specific edits to maximize the number of clean claims. We also provide charge capture audits and charge data reviews to ensure that all procedures, services, supplies and drugs have been captured.

Claim Management

We ensure appropriate and timely submission of claims and track claim status. We submit scrubbed claims either through any industry standard state-of-the-art clearing houses.

Payment Posting And Balance Billing

Our team of specialists post payments to patient accounts and identify claims for denial and underpayment recovery. Any unpaid / denied claims are identified for further action. Any balances as per the primary payor are either billed to secondary payors or the patients.

Denials and Underpayment Recovery

You can outsource your hard-to-collect or outstanding claims for complete recovery. You can also outsource your contract management services to us to ensure that you are getting paid in compliance with your payor contract and help you prepare for your payor contract negotiations. Our team pursues every claim to its logical conclusion and provides you detailed reports on activities for each claim maximizing your revenue as well as visibility.

Patient Balance Collection

We use innovative technology-assisted processes, along with patient advocacy to optimize collections and shorten lead times on collection of patient balances. We provide you daily visibility on patient balances as well as prepare standard bad-debt reports for your further actions.

RCM Analytics

We provide infographic view of your practice’s claims, collections, receivables, and denials with average turnaround times with drill down reports to track finer details of claims. We can also help you glean insights from your practice to convert into action plans to improve your performance.

We understand the challenges of maintaining financial performance, keeping pace with regulatory changes, reducing costs and improving service delivery and payments. We can provide end-to-end RCM services as your outsourced services partner, for all of your revenue cycle management needs or as a stand-alone service or on a project basis.

Virtual Front Desk

We understand the current challenges faced by medical offices and the need for skilled and stable staff. We collaborate with your front office to ensure collection of all necessary information, pre-authorization, eligibility verification, scheduling of appointments and collection of co-pays, and patient billing, to ensure that you are able to maximize your patient collection while balancing patient satisfaction. We believe these processes not just improve your collection and visibility but also help the overall health of your operations.

Credentialing and Enrollment Support

We realize that the credentialing and enrollment are duplicative and painful processes and take away your focus from time spent with patients. HSPL can deliver services for your credentialing and enrollment needs including documentation, verification, submission and maintenance of records.

Analytical Services

We can conduct frequent analyses for your revenue cycle management processes to improve performance and ensure compliance. We provide contract management services, payment integrity and validity checks and code reviews.

Intermediary Services

We provide support to patients and payors by providing ‘Expert Services’ that help patients navigate complex insurance policies to determine which one suits their situation the best. We also continue to support the patients during their treatment by providing expert opinions by qualified physicians to ease their decision-making. We aim to provide these third-party, impartial and independent services as a neutral vendor and help both patients and payors to ensure targeted, required treatment for patient while managing the cost and duration for the payor. HSPL also acts as a third-party processor of insurance claims for the patients.