complete revenue cycle management services: groupone medical billing experts
TRANSCRIPT
Revenue Cycle Management
Who we are
Declining Reimbursement is the #1 Challenge
62% of physicians said declining reimbursement is their biggest challenge to profitability.
SOURCE: 2015 Practice Profitability Index Report
What is causing the decline in reimbursement?
1. Payers aren’t paying the contracted rate2. I can’t find qualified labor3. Denied claims aren’t being appealed4. Inefficient processes5. Patient pay collections are low6. Improper coding7. Practice changes-ownership transitions8. Not all charges are being captured9. Claims not going out-timely filing10. Not optimizing our EHR or PM software
$According to CMS, a full 30 percent of claims are denied or ignored on first submission.
And a full 60 percent of those claims are never resubmitted, which means a medical practice never gets paid.
70% are payable if resubmitted correctly.
Downcoding can cost a single doctor $40,000 in lost
revenue each year, according to a study
published in Medical Economics.
25-30% of lost medical practice income is due to improper billing.
Outsourcing.
How can practices overcome these challenges?
How we solve these challenges for our customers
Certified Coders
Patient Services
Payment Posters
U.S. Customer Advocate
EDI Specialist
Quality Control Audit Staff
Profit Maximizer
Reimbursement Claims Follow Up Specialists
97%Of business managers confirm that an innovative, seamless RCM/EHR/PM system would greatly improve productivity and profitability.
97%
The Top 5 Reasons Healthcare Firms Outsource RCM
Source: PricewaterhouseCoopers – Outsourcing comes of age: The rise of collaborative partnering 2012
Lower costs (important or very important for 76% of respondents)
Gain access to talent – 70%
Farm out activities other can do better – 63%
Switch to more flexible variable cost business model – 56%
Focus on higher value activities & key initiatives such as:• Improving patient care, outcomes, & relationships-43%• Developing new products & services-37%• Expanding-33%
Practices See Results with RCM Services
realized a reduction in A/R days AND achieved higher
collections.
decreased denied claims
reported access to better reporting &
analytical tools
An MGMA study found that practices see measurably improved performance with outsourced billing.
Source: MGMA. Medical Billing Services Information Exchange: #4840. Based on MGMA Survey: Medical Billing Companies Produce Strong Results, 2009. (http://www.mgma.com/store/Books/Medical-BillingServices/)
Tiffany VuPractice ManagerTampa Cardiac Specialists
Working with Group One is a pleasure, they are prompt to make changes that I request for our clinic and my providers’ preferences. They are quick to respond to any coding or claims questions that I may have.
My liaison [customer advocate], Cori, is great! We have conference calls on a regular basis, and I get everything my office needs to maximize our payments.
““
What comes with GroupOne RCM?
A full suite of services and tools to help clients address modern day challenges via:
• Concierge Account Management• Profit Maximizer Technology• Patient Services• Customized reporting• Specialty Specific Certified
Professional Coding Teams
Some services are only partial RCM
PRE-SERVICE POINT OF SERVICE POST-SERVICE BILLING & COLLECTIONS
ANALYSIS A/R MANAGEMENT
CREDENTIALING
SCHEDULING
REFERRAL MANAGEMENT
INSURANCE ELIGIBILITY VERIFICATION
INBOUND SERVICE AUTHORIZATION CODING SERVICES
CHARGE ENTRY
POS COLLECTIONS
CHECK-IN REGISTRATION
ASSIST WITH CHARGE CAPTURE
CLAIM SCRUBBING
CLEARINGHOUSE EDITS
CLAIM SUBMISSION EDI & PAPER
CLAIM RECONCILIATION
CLAIM RESOLUTION
PATIENT CUSTOMER SERVICE
REFUNDS & OVERPAYMENTS
DENIAL MANAGEMENT
A/R FOLLOW-UP DELINQUENT ACCOUNTS
INSURANCE FOLLOW-UP
PATIENT STATEMENTS
PAYMENT POSTING ERA & PAPER
FINANCIAL RECONCILIATION
PERFORMANCE REPORTING
DASHBOARDS
INSIGHT REPORTING
DATA WAREHOUSE REPORTING
CODING AUDITS
TRANSITION TO COLLECTIONS
APPEALS MANAGEMENT
ACCOUNT MANAGEMENT/
OVERSIGHT
Client
3rd Party Services
RCM Services
GroupOne RCM is a Complete Solution
PRE-SERVICE POINT OF SERVICE POST-SERVICE BILLING & COLLECTIONS
ANALYSIS A/R MANAGEMENT
CREDENTIALING
SCHEDULING
REFERRAL MANAGEMENT
INSURANCE ELIGIBILITY VERIFICATION
INBOUND SERVICE AUTHORIZATION
CODING SERVICES
CHARGE ENTRY
POS COLLECTIONS
CHECK-IN REGISTRATION
ASSIST WITH CHARGE CAPTURE
CLAIM SCRUBBING
CLEARINGHOUSE EDITS
CLAIM SUBMISSION EDI & PAPER
CLAIM RECONSILIATION
CLAIM RESOLUTION
PATIENT CUSTOMER SERVICE
REFUNDS & OVERPAYMENTS
DENIAL MANAGEMENT
A/R FOLLOW-UP DELINQUENT ACCOUNTS
INSURANCE FOLLOW-UP
PATIENT STATEMENTS
PAYMENT POSTING ERA & PAPER
FINANCIAL RECONSILIATION
PERFORMANCE REPORTING
DASHBOARDS
INSIGHT REPORTING
DATA WAREHOUSE REPORTING
CODING AUDITS
TRANSITION TO COLLECTIONS
APPEALS MANAGEMENT
ACCOUNT MANAGEMENT/
OVERSIGHT
Client
3rd Party Services
RCM Services
PM Software Configuration and Set Up, Self Serve Knowledge Base, Training, Customer Advocate
FRONT DESK TRAINING
QUALITY CONTROL AUDIT STAFF
Complete transparency.
No long term contract.
EHR agnostic.
GroupOne RCM is a Complete Solution
PRE-SERVICE POINT OF SERVICE POST-SERVICE BILLING & COLLECTIONS
ANALYSIS A/R MANAGEMENT
CREDENTIALING
SCHEDULING
REFERRAL MANAGEMENT
INSURANCE ELIGIBILITY VERIFICATION
INBOUND SERVICE AUTHORIZATION
CODING SERVICES
CHARGE ENTRY
POS COLLECTIONS
CHECK-IN REGISTRATION
ASSIST WITH CHARGE CAPTURE
CLAIM SCRUBBING
CLEARINGHOUSE EDITS
CLAIM SUBMISSION EDI & PAPER
CLAIM RECONSILIATION
CLAIM RESOLUTION
PATIENT CUSTOMER SERVICE
REFUNDS & OVERPAYMENTS
A/R FOLLOW-UP DELINQUENT ACCOUNTS
INSURANCE FOLLOW-UP
PATIENT STATEMENTS
PAYMENT POSTING ERA & PAPER
FINANCIAL RECONSILIATION
PERFORMANCE REPORTING
DASHBOARDS
INSIGHT REPORTING
DATA WAREHOUSE REPORTING
CODING AUDITS
TRANSITION TO COLLECTIONS
APPEALS MANAGEMENT
ACCOUNT MANAGEMENT/
OVERSIGHT
Client
3rd Party Services
RCM Services
PM Software Configuration and Set Up, Self Serve Knowledge Base, Training, Customer Advocate
FRONT DESK TRAINING
QUALITY CONTROL AUDIT STAFF
DENIAL MANAGEMENT
Less than 5% unexpected
rejection rate
Routinely receive clearinghouse
99% clean claim reward
Success rate at overturning
denials
Effective & Advanced Clean Claims Process
Monthly Reports
• Patient Collections• Unbilled Claims• CPT Utilization• Claims on Hold• Tailored Management Areas – Every client has specialized focus areas
• Summary Dashboard• A/R Aging Analysis
-Insurance and Patient• Denials and Adjustment Analysis• Credits• Charge Volumes• Cash Flow / Payment Received
Discuss the results and understand what they mean.
Why Choose GroupOne?
Meet Your Goals
Experience You Can Trust
Increase Cash Flow & Efficiency
Advanced Analysis & Review
No complicated interfaces
Schedule a Free Practice Analysis
Are you missing out on revenue opportunities?
Reserve a free, online, HIPAA compliant revenue analysis with us today.
Email our sales team to set up your [email protected]