NANO Revenue Cycle Management
What is Nano Revenue Cycle Management?
Nano Revenue cycle management is the approach or the plan of action created by service provider to make sure they observe, manage, and administer the clinical functions ongoing between the healthcare Provider and the Patient, in their revenue cycle. The revenue cycle begins as soon as a patient reaches out to the healthcare provider to schedule an appointment and ends when all payments for the appointment,consultation, and treatment have been collected.
The main goal of Revenue Cycle Management is to identify any variables that can slow down patient engagement or the care continuum in the provider’s revenue cycle and identify the root cause of it and resolve them. With proper revenue cycle management adherence, due diligence reporting, and best practice sharing techniques, care providers can maximise their claim reimbursements and increase their revenue without wasting a lot of time.
The major steps of Revenue Cycle Management include
Scheduling :
Our Patient Scheduling includes effective capture of Patient information for determination of eligibility, obtaining prior authorization, and determining patient liability. This feature arranges the delivery of care and reduces the long waiting time that patients typically experience.
Patient Pre-Registration :
Our pre-registration services allow our clients to reallocate valuable resources towards other core functions that have a direct impact on their business and operations which ensures that the patient information is entered correctly and efficiently while verifying that the medical claim contains all of the proper information.
Patient Registration :
Our patient registration services include components such as demographics, care details, insurance, and payment information. It improves the clean claim submission rate and facilitates quick processing of claims.
Charge Entry & Capture :
The most important aspect of Nano Revenue Cycle Management is, it can either be automated, where all the necessary information can be automatically fed into the practice management billing side based on the information provided during the documentation by the provider or it can be done the old-fashioned way, where front desk staff will have to enter all information manually and then send it to billing, where it will be keyed in.
Medical Coding :
Nano Revenue Cycle Management makes it easy to get the professional medical billing and coding services, credentialing, and education you need to start or grow your practice which takes the billing burden off the medical office, liberating providers and staff to concentrate on patient care.
Eligibility & Benefits Verification :
Using Nano Revenue Cycle Management, confirm the Patient's eligibility, verify the benefits, obtain requisite authorizations before the patient visit, and reduce claim denials with Workflows received through the patient scheduling system, EDI, Fax, emails, and FTP files.
Claim submission :
A very important and crucial process in Nano Revenue Cycle Management is the claims submission as it includes parsing of claims information from the revenue cycle system to the clearinghouse and addresses any throwbacks. The scrubbing process enables the medical billers to address the claims.
Denial Management:
This feature in Nano Revenue Cycle Management helps investigate the reason for every denied claim. Focus on resolving the issue. Resubmit the request to the insurance company which means that Denial Management is one of the most important pieces of a health Revenue Cycle.
Insurance Follow-Up :
In this stage, Nano Revenue Cycle Management practices look at not only what has been paid, but also what has not been paid. What happens to the items that don't get paid? The accounts receivable (A/R) report shows everything that's sitting in the insurance and/or patient buckets for a period of time. This report will show if insurance follow-up is broken and why it is taking so long to get it paid.
Remittance processing :
Remittance processing begins after a practice's claims are processed. The explanation of benefits shows the practice what they were paid for the services provided. During the allowable - a provider's contracted prices with the payer - are determined.
Patient Billing & Collection:
Our Patient Scheduling includes effective capture of Patient information for determination of eligibility, obtaining prior authorization, and determining patient liability. This feature arranges the delivery of care and reduces the long waiting time that patients typically experience.
Cash Posting :
This involves reconciling incoming claims against what was actually paid or denied. It is important to get this step right for accurate reporting. for example, if you deny a claim, but it still gets posted as paid (or vice-versa) it can mess up your reports and make them inaccurate in terms of timeliness & accuracy.
Reporting:
The crucial aspect of Nano Revenue Cycle Management has always been about communication between stakeholders within an organization such as physicians or hospitals who submit claims based upon services rendered.
Benefits of Revenue Cycle Management
Increased average % of claims paid after 1st submission :
The major focus area for Revenue Cycle Management to ensure claims are paid the first time they’re submitted and it is all about how accurately and quickly front-end team finish off the assigned claims . These front-end tasks include insurance verification, collection of accurate patient information, and precise coding.
On average, 5% to 10% of claims are denied after their first submission. However, these denials are mostly due to a human error or related to any technical glitch. As per the recent survey, 90% of these denied claims can be avoided and the best way to do it is to make sure the data during the claims submission is accurate. When claims are denied, they go from pillar to post between insurance companies and providers for months until the complete patient data is fixed and verified thoroughly.
Increased average percent of current claims :
Using Nano Revenue Cycle Management, you can improve your average current claims by keeping check and trying to reduce the rate of claims rejection, shortening payment lag, improving appointment scheduling, modernizing the claims process, and automating patient eligibility check.
Major attention has to be given to avoid technical errors and fraud investigations so that healthcare providers can promptly receive reimbursements for their services. Beyond this, they can avoid spending thousands of dollars on resolving errors, appealing claims, and investigating fraud.
Reduced denial rate:
The Nano Revenue Cycle Management solution significantly helps organizations in handling denial management more efficiently by reducing errors and providing all the needed information. It helps reduce claim denials by insurance companies as well as government payers.
The procedure involves determining the cause of the claim denial and assessing if the denial can be appealed. Using our revenue cycle management with an expert team can result in a 99% first-pass acceptance rate.
