REVENUE CYCLE MANAGEMENT 

 

We offer full-service RCM capabilities, and our solutions address the entire claims lifecycle, from patient eligibility checks to financial reconciliation. This comprehensive workflow ensures that we manage all aspects of reimbursement. This workflow will allow us to address any gaps in RCM workflow and optimize the reimbursement opportunity.​

• 98% Clean Claims Submission Rate

• 92% First Pass Claims Payment Rate

• 92% AR Under 75 Days

• 98%< Workers Com Contract Compliance Rate

• 98%< Coding Audit Accuracy

• Trizetto clearinghouse tracks the quality of claims submitted, and EMPClaims has consistently qualified with a 99% and higher clean claims ratio, ensuring a class-leading 85% and higher first-pass payment rate.

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RCM OVERVIEW

 

Broad Domain Expertise: 

• Laboratories

• Urgent Care Providers

• Worker Comp 

• Internal Medicine

• Family Medicine

• DME/Pharmacy

 

RCM Lifecycle Services:

• Credentialing

• Payor Contracting

• Contract Negotiation/Renegotiation

• Eligibility

• Cost Estimates

• Coding

• Patients

• AR Follow Up

 

EMR Interoperability:

The RCM team has extensive system integration expertise with the leading outpatient EMR systems.   We directly interface with most EMR/ PM combined systems or through HL7 integrations are also available as needed.  Common integrations include:

• Athenahealth

• Epic

• eClinicalWorks

• iSYSTOC

• daisyBill

• kareo

• dr chrono

• Advanced MD

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SCOPE OF SERVICES

 

Billing and AR:

• Once billing data is received from the LIS, the RCM billing team will check eligibility, review charges, and submit all claims.

• Manage any rejections, denials, or unpaid claims.

• If medical records or test results need to be submitted to payers to appeal denials, our team will extract reports from the LIS and submit appeals.

 

Fee Schedule Adherence:

• Load all payer and send appeals for underpayments as part of our AR workflow.

• We will need access to all-payer contracts. 

• Payer enrollments and credentialing will be the responsibility of the Client.

 

Payment Posting and Financial Closing:

• Post all ERA and EOBs.

• Apply adjustments and write offs based on guidelines approved by Client.

• If there are exceptions, we will work with Client’s finance team for resolution.

 

Patient Billing:

• We will send patients 3 patient statements for open balances.

• Once the statement cycle is completed, migrate balances to a collection company designated by Client.

• Patients will have the option to pay online or call our call center to make payment arrangements.

• All incoming patient calls with billing questions will be handled by our patient service center.

 

Reporting and Analytics:

• Will assume responsibilities for Monthly, Weekly reporting on performance will be the responsibility

• Work with Client to create reporting dashboards as required.

 

Account Management:

• A dedicated Account Manager from EMPClaims is assigned to the practice for ongoing issues management.

• We would require support from Client for managing highlighted exceptions.