Healthcare Revenue Cycle Management Solutions

 

AdvantEdge provides comprehensive revenue cycle management and business management solutions for healthcare providers. Our solutions include:

 

All are delivered with a focus on the best results for your practice and/or hospital. With ClientFirst service.

Please contact us today to learn more: 877 501-1611 or info@ahsrcm.com

 

Revenue Cycle Management

Revenue Cycle Management or RCM typically refers to the entire medical billing process, from beginning to end.

Medical Billing Services from professional medical billing companies typically encompass the entire revenue cycle. The revenue cycle includes

  • Capturing, entering, and editing (“scrubbing”) the information needed to create a medical billing claim (to an insurance company or payer). This includes “demographic” information about the patient including insurance coverage details and “charge” information: a combination of CPT and ICD-9 codes determined by the physician or a coder.
  • Coding can be performed by the physician, with our without the use of EMR/EHR technology, by a coder in the practice, or by a certified coder working for a medical billing company. Coding rules are complex and change on a regular basis and coding must be done accurately or the practice will face compliance risk. Recent expansions of Medicare and OIG audits have increased this compliance risk.
  • Front end edits make sure that all information is accurate and consistent so that the claim will be accepted by the payer (insurance company). The measure used is typically “first pass claims acceptance rate.”
  • Claims are filed electronically using medical billing software and EDI technology or on paper. Most payers now accept electronic filing, but some smaller payers still require paper.
  • Once payment and the associated information are received, the information is posted. The key information includes the EOB: explanation of benefits. Payments can be posted electronically when received as an ERA: electronic remittance advice, sometimes referred to by its ANSI number: 835.
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