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3 STEPS TO HANDLE AR AND CREATE AN EFFECTIVE RCM CYCLE

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  1. 1) Understanding Payor Rules

Insurance companies have their own set of rules that every revenue cycle management company must be aware of. The way claims are handled by Aetna may differ from the way BCBS or Cigna might handle the claim. Further, every insurance company has its provider reimbursement policy. So the difference between a good medical billing company and an excellent medical billing company is the difference in the claims first review pass rate. It all depends on how the claims are prepared, adhering to the payor’s rules, leading to fewer denials. And therefore, a much better rate of provider reimbursement. Bristol Healthcare Services consistently ranks among the best since we have a high first claim pass rate. Every claim sent to the insurance company is scrubbed for code edits by payor. If a claim is denied, Bristol Healthcare Services immediately works on the denial to determine the issue causing the claim to be denied and makes sure to carry out the necessary amendments. Speaking about denials… 

2) Understanding Denial Management

There are multiple reasons a claim might get denied. The most common reasons are:

  • Inconsistent procedure codes (CPT codes).
  • Inconsistent Diagnosis code (DX Code).
  • Authorization not being obtained.
  • Inclusion of Non-covered services as per the patient or the provider’s plan
  • Missing information on the claim.

There are about 40+ reasons for denials that every billing company focuses on eliminating and Bristol Healthcare Services is no exception. When a claim gets initially filed, there are multiple teams to handle all the necessary processes, from credentialing the provider with the insurance companies, coding the claim as per the payor rules, to filing the claim and getting the reimbursement for it. Some claims may require the patient to be contacted; Bristol Healthcare Services takes care of that, thus easing the providers’ work. If the claims are not submitted on time or not as per the insurance company’s rules, then the payor denies the claim and further amendments on the claim are prohibited. Re-submitting a claim results in a loss of money for the provider and the billing company. Suffice to say; a good medical billing company will make sure the claim passes through at the first touch as it makes everything easier for everyone involved.

3) A Revolution in Automation – RCM tool kit

A hospital might have tens of thousands of patients who will have their insurance plans with various payors. It will be a monumental task to handle all the paperwork manually. Every provider/medical facility would be having its own RCM tool kit, which registers the patients, records patient details, records every stage of the claims process and more. There are many different RCM tool kits and our expert billers at Bristol Healthcare Services can seamlessly handle almost all the major RCM tool kits being used in the country. There are also online portals to store information safely. Bristol Healthcare has invested in the latest hardware and software so that our clients receive the best services. Our knowledgeable billers and coders, together with the latest technology, ensure that our clients have a stress free experience with their back-office work.

While it is impossible for any company to produce zero claim denials, we at Bristol Healthcare have a high first-pass claim rate. We strive every day so that we can achieve a 100% claim pass rate.