Revenue Cycle Management

Optimizing Your Practice’s Financial Health with Simplified Billing and Strengthened integrity

In 2014 the revenue cycle management market was valued at $18.3 billion (Ref.: 25 things to know in Revenue Cycle Management, Murphy Brook) and at $260 billion in 2020 (Ref.: Revenue Cycle Management Market Share Report) We will streamline your financial process, reduce overhead administrative costs, no more hiring and training staff, reduction in denied claims, increase in cash-flow, and improved quality patient care.

Managing the revenue cycle in healthcare is complex, involving multiple steps from patient intake to payment collection. At Cosmos Medical Management, we specialize in Revenue Cycle Management (RCM) services designed to streamline your financial operations, improve cash flow, and reduce administrative burdens. Our comprehensive RCM solutions ensure that your practice remains financially healthy, compliant, and efficient.

Our RCM service optimizes each stage of the revenue cycle to ensure timely reimbursements, reduce claim denials, and improve overall financial performance.

Our Comprehensive RCM Services Includes:

1. Eligibility Verification

  • Gather Patient Information: Collect basic details such as name, date of birth, insurance provider, and policy number.
  • Verify personal identification: We verify personal identification through driver’s license and/or insurance card.
  • Check Insurance Coverage: Use an eligibility verification system or contact the insurance provider to confirm active coverage, policy details, and exclusions.
  • Review Requirements: Determine if the patient meets program eligibility (e.g., Medicaid, Medicare, commercial insurance). Check if pre-authorizations or referrals are needed.
  • Verify Benefits and Limitations: Confirm the services are covered under the patient’s insurance plan. Identify deductibles, co-pays, and out-of-pocket expenses.
  • Confirm Provider Enrollment: Ensure that the healthcare provider is within the patient’s network.
  • Notify the patient: Notify the patient of coverage details, co-pays, deductible, and any required steps.

2. Charge Capture and Coding

  • Accurate Charge Capture: We ensure that every service provided is captured accurately to prevent revenue leakage. Our charge capture processes are integrated with your clinical workflow to ensure no charges are missed.
  • Medical Coding: Our experienced and certified coders use the latest coding systems (ICD-10, CPT, and HCPCS) to ensure accurate and compliant coding, reducing claim denials and optimizing reimbursements.

3. Claims Submission and Follow-Up

  • Timely Claims Submission: We submit claims promptly to insurance providers and follow up to ensure that claims are processed correctly the first time.
  • Claims Management: We track and monitor claims to resolve any issues quickly, addressing underpayments, denials, or delays, and ensuring the fastest reimbursement possible.

4. Denial Management and Resolution

  • Denial Analysis: Our team identifies the root cause of denied claims and implements strategies to reduce future denials. We appeal against denied claims efficiently, reducing the time spent on outstanding balances.
  • Denial Prevention: By analyzing trends in claim denials, we implement preventive measures to improve the accuracy and efficiency of future submissions.

5. Payment Posting

  • Accurate Payment Posting: We ensure that all payments received, whether from patients or insurers, are accurately posted to the corresponding accounts, providing a clear picture of your practice’s financial health.
  • Account Reconciliation: We perform regular account reconciliations to identify discrepancies, resolve billing issues, and ensure that your practice’s financial records are always accurate.

6. Patient Billing and Collections

  • Clear Billing Statements: We generate easy-to-understand patient statements, ensuring transparency and reducing confusion regarding payment expectations.
  • Payment Plans and Collections: We work with patients to offer payment plans and ensure timely collections, helping you maintain consistent cash flow while accommodating patient needs.

7. Reporting and Analytics

  • Comprehensive Financial Reports: We provide detailed, actionable financial reports, including accounts receivable aging, revenue trends, and payer performance. These insights help you make informed decisions for better practice management.
  • RCM Performance Tracking: We continuously track key performance indicators (KPIs) to identify opportunities for improvement and ensure the efficiency of your revenue cycle.

Why Choose Cosmos Medical Management for Revenue Cycle Management?

  • Comprehensive and End-to-End Solutions: Our RCM services cover every aspect of the revenue cycle, from eligibility verification to payment collection, giving you a fully integrated solution to manage and optimize your practice’s financial health.
  • Experienced Team of Experts: With years of experience in healthcare billing, coding, and financial management, our team has the expertise to handle complex billing and coding challenges, reduce denials, and improve revenue cycle efficiency.
  • Maximized Reimbursements: We work diligently to ensure your claims are processed accurately and promptly, maximizing reimbursements for your practice and reducing the time it takes to get paid.
  • Improved Cash Flow: Through our proactive claims follow-up and payment posting services, we help you maintain a healthy cash flow by reducing delayed or denied payments and ensuring timely reimbursements.
  • Compliance and Risk Reduction: We ensure that your practice remains compliant with ever-changing healthcare regulations and payer policies. Our solutions reduce the risk of audits, penalties, and other compliance issues, keeping your practice secure.
  • Customized Solutions for Your Practice: We understand that every practice has unique needs. Our RCM services are tailored to meet the specific requirements of your specialty and patient demographic, ensuring maximum efficiency and results.

Benefits of Revenue Cycle Management with Cosmos Medical Management

  • Improved Cash Flow: We ensure that your practice gets paid quickly and accurately for the services you provide.
  • Reduced Administrative Burden: Let our expert team handle the complexities of billing, coding, and reimbursement so you can focus on patient care.
  • Increased Efficiency: Streamline your operations with end-to-end RCM solutions that eliminate redundancies and improve workflow.
  • Better Financial Insights: Access detailed reports and analytics that help you make informed financial decisions and improve overall practice performance.
  • Minimized Risk of Denials and Audits: With our comprehensive approach to coding, claims management, and compliance, we reduce the risk of denials and audits, ensuring that you’re paid fairly for your services.

Contact Us, if you’re ready to optimize your practice’s revenue cycle, reduce claim denials, and improve your financial performance, let Cosmos Medical Management help. Our expert team is here to streamline your RCM process and maximize the financial success of your practice.