Revnucare, a trailblazer in revenue cycle management (RCM), combines cutting-edge technology with skilled human labor to optimize clinical documentation processes. Our mission is to reduce costs, accelerate cash flow, and enhance revenue for providers and payers. Let’s delve into the specifics of our services:
Eligibility verification is the cornerstone of revenue cycle management. Revnucare employs a multifaceted approach to ensure accurate billing and minimize claim denials:
-
Automated Verification:
- Our robust software interfaces with payers’ systems, instantly confirming patient eligibility.
- Real-time updates keep providers informed of any changes in eligibility status.
- By identifying ineligible patients early, we prevent claim denials due to eligibility issues.
-
Benefits Assessment:
- We delve into the specifics of each patient’s insurance plan:
- Covered services
- Co-pays
- Deductibles
- This detailed assessment ensures accurate billing and reduces financial surprises for patients.
-
Customization and Communication:
- Patient statements are customized to provide a breakdown of services rendered, insurance coverage, and outstanding balances.
- Multichannel delivery (mail, email, secure portals) ensures patients receive and understand their statements.
Clear, concise patient statements are crucial for prompt payments. Revnucare’s approach includes:
-
Frequency:
- We generate patient statements every 15 days.
- Regular statements encourage timely payments and reduce outstanding balances.
-
Customization:
- Each statement is tailored to the individual patient:
- Services provided
- Insurance coverage details
- Outstanding balances
- Transparency fosters patient trust and cooperation.
-
Multichannel Delivery:
- Patients receive statements via multiple channels:
- Mail: Traditional paper statements
- Email: Convenient and eco-friendly
- Secure Online Portals: Accessible anytime, anywhere
- Our customer service team assists with any patient queries related to these statements.
Risk adjustment is pivotal for accurate revenue predictions. Revnucare’s expertise ensures optimal financial outcomes:
-
Data-Driven Insights:
- We analyze patient data, including diagnoses, demographics, and historical costs.
- Accurate risk scores inform payment adjustments.
- Our team identifies Hierarchical Condition Categories (HCCs) to capture the severity of chronic conditions.
-
Value-Based Care Alignment:
- Revnucare aligns risk adjustment strategies with value-based care models.
- Quality outcomes and financial stability go hand in hand.
- By optimizing risk adjustment, we enhance both patient care and revenue.
Denial management is essential for maintaining revenue flow. Revnucare’s approach includes:
-
Root Cause Analysis:
- We identify common denial reasons:
- Coding errors
- Missing documentation
- Eligibility issues
- Swift rectification prevents recurring denials.
- We identify common denial reasons:
-
Appeals Process:
- When a claim is denied, we:
- Gather comprehensive documentation
- Navigate the appeals process
- Timely appeals lead to faster reimbursement.
- When a claim is denied, we:
-
Predictive Analytics:
- Our system predicts potential denials based on historical data.
- Proactive action prevents revenue leakage.
Value-Based Care Models are essential for aligning financial incentives with quality outcomes. Revnucare’s expertise includes:
-
Quality Metrics:
- We track performance metrics:
- Readmission rates
- Patient satisfaction scores
- Preventive care adherence
- These metrics optimize reimbursement.
- We track performance metrics:
-
Alternative Payment Models (APMs):
- Revnucare navigates APMs, including:
- Bundled payments
- Shared savings
- Pay-for-performance
- Aligning with evolving models ensures financial success.
- Revnucare navigates APMs, including:
-
Population Health Management:
- Enhancing preventive care and reducing costs benefit both patients and providers.
- Revnucare actively supports population health initiatives.
Interoperability and data exchange are critical for efficient healthcare operations. Revnucare’s approach includes:
-
Health Information Exchange (HIE):
- Our systems facilitate seamless data sharing among providers, payers, and patients.
- Interoperability enhances care coordination and reduces administrative burdens.
-
Interoperability Standards:
- Revnucare adheres to industry norms (HL7, FHIR).
- Accurate information flow across systems ensures efficient RCM.
-
Data Integrity:
- During transitions (e.g., EHR to billing system), we maintain data accuracy.
- Consistent, reliable data prevents revenue discrepancies.
Compliance and regulatory adherence are critical to maintaining operational integrity and avoiding penalties. Revnucare’s approach includes:
-
HIPAA Compliance:
- Safeguarding Patient Data: Revnucare prioritizes patient data privacy and security. Our processes adhere strictly to the Health Insurance Portability and Accountability Act (HIPAA) guidelines.
- Secure Systems: Our technology infrastructure ensures encrypted data transmission, restricted access, and robust authentication protocols.
- Regular Audits: We conduct periodic audits to verify compliance and promptly address any gaps.
-
ICD-10 and CPT Coding:
- Coding Accuracy: Our certified coders stay updated on the latest ICD-10 (International Classification of Diseases, 10th Edition) and CPT (Current Procedural Terminology) codes.
- Minimizing Compliance Risks: Accurate coding prevents claim denials and regulatory penalties.
- Documentation Integrity: We maintain detailed records to support coding decisions.
-
Audits and Training:
- Ongoing Staff Training: Our team receives regular training on compliance requirements, coding updates, and documentation practices.
- Internal Audits: We proactively assess our processes, ensuring alignment with industry standards.
- External Audits: Independent audits validate our compliance efforts.
