This package provides coverage for any and all processes entailed under RCM. By opting for this plan, you save funds for Social Security and employee health benefits while eliminating other overhead costs. The FTE employees do not take leave, and there is never downtime for your service.
AR Follow up – Insurance
This plan is ideal for providers that only require assistance in the data entry portion of the claims process. This solution was created for providers whose data entry staff is unavailable temporarily or permanently.
We provide customized pricing models that best suit your practice’s needs. Whether you’re looking for one-off support or support as you scale, we offer pricing plans tailor-made for your business. Our plans offer 40% cost savings over the competition.
There’s three ways to charge your clients – by percentage, per claim, or hourly. This should be specified in the contract you sign with your client.
Percentage involves charging a client based on the monthly revenue collected. The percentage charged depends on what services are performed, location, competition, and type of practice. A practice the sees fewer patients but averages a higher charge per visit may warrant a lower percentage than a family practice who sees several patients daily at a lower cost per visit. I’ve typically seen medical billing fees from 6 to 10% depending on the area and $3.50 to $5 per claim for claim filing only. Also make sure percentage based billing is legal in your state. For special projects like aging a higher percentage is justified due to the additional time and effort required. I’ve seen fees in the 15% and higher range for working aging.
Per claim charges are more suitable when a biller is only submitting claims with no other services. Some clients who don’t have the time or ability to file claims may request this service.
Charging per hour may be more appropriate when percentage or per claim charges are not feasible. This is usually a better option for clients who don’t see a lot of patients and charging per claim or percentage would not be worth your effort. I have charged per for special projects when charging per claim was just not worth
it or performing more of a consulting role. I started out charging hourly for what is now one of my largest clients so you may consider this a way to get your foot in the door.
A) Medical Billing is the process of submitting health insurance claims on behalf of the patient to various health insurance payers for the purpose of acquiring payment for services rendered in a medical facility.
The Revenue Cycle Management includes all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue, according to the Healthcare Financial Management Association (HFMA). Revenue cycle management (RCM) is the financial process, utilizing medical billing software that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with protected health information (PHI) must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance. Covered entities (anyone providing treatment, payment, and operations in healthcare) and business associates (anyone who has access to patient information and provides support in treatment, payment, or operations) must meet HIPAA Compliance. Other entities, such as subcontractors and any other related business associates must also be in compliance.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015.
MACRA created the Quality Payment Program that:
• MACRA also required us to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.
• Repeals the Sustainable Growth Rate.
• Changes the way that Medicare rewards clinicians for value over volume.
• Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS).
• Gives bonus payments for participation in eligible alternative payment models (APMs).
The Merit-Based Incentive Payment System (MIPS) is the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty, or no payment adjustment.
MIPS streamlines 3 currently independent programs to work as one:
• Electronic Health Record Incentive Program/Meaningful Use (MU)
• Physician Quality Reporting System (PQRS)
• Value-Based Modifier (VBM)
MIPS also adds a fourth component, Improvement Activities (IA), to promote ongoing improvement and innovation. This new program will ease clinician burden and allow clinicians to choose the activities and measures that are most meaningful to their practice to demonstrate performance.