Hyderabad
info@promantraglobalconnect.com
Ensuring efficient revenue cycle management, so healthcare providers can focus on what matters most—your well-being. Our expert RCM services optimize financial performance, streamline operations, and enhance patient care.
We offer accurate billing and coding services to maximize your reimbursements while minimizing errors and delays. Our claims management ensures smooth submission and follow-up, reducing denials and speeding up payments. By focusing on revenue optimization, Our dedicated denial management team works to resolve claim rejections quickly, ensuring minimal revenue loss.
Insurance verification confirms patient coverage and eligibility. Authorization ensures that services are approved by the insurer. This step prevents unnecessary claims denials and reduces revenue losses.
Clean claims are prepared and submitted electronically or manually to payers. Claims include patient demographics, service details, and charges. Accuracy and completeness are critical to avoid rejections and denials.
Payers review claims for accuracy, completeness, and adherence to guidelines. Approved claims are reimbursed according to contractual rates. Denied claims require rework, appeal, or write-off.
Payments are posted to patient accounts, and reconciliation ensures accuracy. This step confirms payment receipt, updates patient balances, and identifies potential discrepancies.
Denied claims are analyzed, and appeals are filed with supporting documentation. Effective denial management minimizes revenue loss and optimizes reimbursement.
Patients receive statements for outstanding balances. Healthcare providers must ensure clear communication, flexible payment options, and timely follow-up to ensure prompt payment.
a cardiology clinic handles a range of complex services, from diagnostic testing to advanced treatments, which require meticulous billing and coding practices. Cardiology services are unique due to their dependence on both technical and professional components, along with stringent compliance and documentation requirements. Here’s a detailed breakdown of key billing aspects specific to cardiology:
Cardiology-Specific Revenue Codes and Bundling Rules
Cardiology Revenue Codes: Cardiology claims may use specific revenue codes tied to inpatient or outpatient services, impacting how insurers reimburse the clinic.
Bundling Rules: Cardiovascular procedures often have bundling requirements where related services are grouped for billing. Medicare and other insurers may bundle certain procedures, like an EKG with a stress test, under one payment rate. Awareness of payer bundling rules can ensure correct billing.
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In 2016, Advay co-founded RCM Industries with a team of like-minded individuals who shared his passion for innovation. The company’s core mission is to provide state-of-the-art resource management solutions that enable businesses to optimize their operations, reduce costs, and increase productivity.
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As the Assistant Team Lead, Narendra plays a pivotal role in shaping the company’s operational strategies and guiding the technical teams. His expertise in systems integration and software solutions has been crucial in developing the cutting-edge tools that RCM Industries offers to its clients.
CPT (Current Procedural Terminology) codes are used to describe medical procedures and services. ICD-10 (International Classification of Diseases, Tenth Revision) codes are used for diagnosing medical conditions. HCPCS (Healthcare Common Procedure Coding System) codes are used for billing Medicare and Medicaid and include non-physician services. Understanding these codes is crucial for accurate billing.
The claim submission process typically involves gathering necessary patient information, verifying insurance eligibility, coding the procedures and diagnoses correctly, submitting the claim electronically or on paper, and following up with the insurance company to ensure timely payment.
First, I review the denial reason provided by the insurance company. I then check the claim details against the denial to identify any discrepancies. If needed, I gather additional documentation or make corrections to the claim before resubmitting. I also maintain communication with the insurance company to understand the denial better and ensure it gets resolved.
I have experience with software such as Epic, Cerner, Meditech, and various billing systems like AdvancedMD and NextGen. I am also proficient in Microsoft Excel for data analysis.
Common reasons include incorrect patient information, invalid or missing codes, lack of authorization, services not covered by the insurance plan, or duplicate claims.
I prioritize my work based on the age of the accounts, the amount owed, and the urgency of follow-ups. I use a systematic approach to ensure timely responses and resolutions.
I once encountered a claim denial due to an incorrect procedure code. After reviewing the documentation and communicating with the provider, I was able to correct the code and resubmit the claim, resulting in timely payment.
A Superbill is a detailed document that includes all the services provided during a patient visit. It serves as the basis for insurance claims and includes relevant diagnosis and procedure codes.
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