Revenue Cycle Management

Revenue Cycle Management

What can Rev Guard do for a Client?

  • Maximize Collections 
  • Accelerate Cash Flow
  • Reduce Denials
  • Improve Productivity
  • Cost Savings

What do we need from a Client?

  • Access to the Electronic Health Records & Practice Management System
  • Hospital Information System
  • Current A/R Data for analysis
  • Periodic RCM Supervisor meetings

Revenue Cycle Management is comprised of the following:

Pre-Visit Patient Encounter Post-visit RCM
  • Patient registration
  • Scheduling
  • Insurance eligibility
  • Benefit authorization
  • Medical necessity
  • Copay
  • Patient balance
  • Insurance card
  • Visit
  • Diagnosis classification
  • Procedure
  • Coding
  • Claim submission
  • Payment posting
  • Claims adjustment/follow-up
  • Electronic adjudication
  • Denial management
  • A/R management
  • Patient billing

What issues do we solve, and how do we solve them?

Patient Eligibility

Increase collections by decreasing denials.

Claim rejection or denial happens WAY too frequently because the patient’s eligibility is not verified pre-visit. 

Payer Remittance

Accurate and efficient submission of claims.

Rev Guard uses proprietary technology and an expert team to scrub claims prior to submission to insure the highest first-pass acceptance and payment by the Payor.  Diagnosis codes, visit types, Procedures, and Claim Modifiers are cross-referenced and reviewed for accuracy. 

  • Rev Guard’s Clean Claim Submission Process:
    • Increase Cash Flow from insurance companies and patients by substantially reducing rejections, corrections, and re-submissions.
    • Update and insure a uniform charge master.
    • Receive full payment for submissions by ensuring all relevant charges are submitted.
    • 98% clean-claim rate achieved by proper claim submissions and reducing rejections.
    • Categorize rejected claims by identifying and quantifying the most common rejections to help prevent them in the future.
    • Correct historical errors from corrected claims via Account Manager consultation.
    • Prioritize claims for maximum revenue
    • Proactively manage outstanding charges to avoid cancellation due to failure to file promptly.
    • Certified Coders review complex and high dollar claims. 
Payer Payment Posting

Analysis and management of payments.

Rev Guard’s expert team will accurately post payments, manage postings through electronic remittance advice (ERA) – thus automating the process of receiving and posting payments. 

  • Rev Guard’s Posting Review Process:
    • Manages and review all payment postings received from insurance companies and patients, whether electronic or manual.
    • Automatically post ERA to HIPAA-compliant Practice Management Systems and Hospital Information Systems, eliminating data entry errors.
    • Proprietary Analytic tools ensure that payments received met payment expectations and that any anticipated payments not received are transferred to the Denials Management Team.
Denial, A/R & Appeal Management

Short pay or Denied claims are reviewed and appealed to collect the fullest payment possible to decrease the number of days that unpaid claims remain in A/R.

Senior members of the Rev Guard Accounts Receivable team address each denied or short payment directly with the Payor to maximize collections in the minimum amount of time.  Simply put, our team monitors all rejected claims and constantly follows-up until they are paid

  • Rev Guard Denials Management Process:
    • Search tools and procedures identify missing payments.
    • Research denied claims with access to denial reasons and remarks.
    • Retrieve and submit additional supporting documents from the Patient Health Record when required.
    • Claim tracking every step of the way to get claims paid completely.
    • Document and Appeal denied and underpaid claims.
    • Identify & Report the most common denial reasons to prevent them from happening in the future.
    • Further, accelerate cash flow by using our online tool to submit secondary claims electronically.
Patient Payment Solutions

Provide a fast, easy, flexible, and convenient method for Patients to make payments.

Rev Guard Patient Billing is a quick and cost-effective way to process patient statements, Billings, and receipts. 

  • Rev Guard Receivables Process:
    • Improve patient communication and satisfaction with clear, concise patient statements.
    • Increase cash flow by having patients pay their bills online via a Patient payment portal.
    • Reduce processing costs by the consolidation of statement information onto one page.
    • Patient follow-up’s – Our patient services team stays in constant touch with your patient to guide and help them to clear their outstanding payments.
    • Electronic patient billing system – Eliminate paper statements and mailing costs by creating and sending patient statements electronically.
Reporting & Analytics Solutions via Real-Time

Rev Guard’s Business Analytics Reporting allows complete transparency to the RCM processes, status and can be reviewed with an Executive view or detailed data views.

  • Rev Guard Analytics Process:
    • Real-Time Identification of rejection and denial trends.
    • Analyze current rejectionsby category and function: patient demographics, eligibility, coding, etc.
    • Identify and correct the root causes of ongoing issues – by Department, Location, or Provider.
    • Providedetailed reporting and analysis of all Write-off claims with recommended corrective action.
    • Focused reporting for each person in the “Information Chain” to match their function.
    • Gain valuable insights into how and when denials occur, the impacted dollar amounts, and which processes have improved by month, quarter, or year-to-date.
    • MonitorPayor payment trends and aggregate data by Payor, Provider, and Procedure code for future use.
    •  
Other Services
  • Rev Guard Coding, Auditing, and Compliance Services

Certified Coders and Auditors are available to assist with the Mandatory requirement of one audit per provider per year and to offer Comparative Billing Reports (CBR) on each provider to determine any level of service trends and/or outliers that may cause a flag for audit with both Government and Commercial payors. We also offer Coding Review services to facilitate garnering the highest legal reimbursement for work performed. Quarterly updates on any coding changes or requirements by payors.

Compliance Plans, Training, and Reviews are also a part of the Rev Guard Revenue Cycle Management services available to all our clients. Compliance Plans became mandatory in 2001.  How up to date is your plan, and have you made the required changes outlined in the OIG Work Plan?

Independent Review Organization services for entities who have come under a Corporate Integrity Agreement (CIA) and require specific audits and reports for compliance as outlined in the CIA. Education and Training are available by Certified Coders and Billing Personnel for this purpose as well.

A Certified Trainer also offers High-Reliability Organization (HRO) training to assist in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity, such as clinics and hospitals.