NANO Revenue Cycle Management
From the appointment to the last riyal collected
The money is earned at the bedside and lost in the paperwork
The revenue cycle opens the moment a patient books and does not close until the last payment for that episode has been collected. Everything in between — eligibility, registration, coding, submission, follow-up — is a chance for earned revenue to stop moving. Most of it does not disappear dramatically; it just sits in accounts receivable getting older.
NANO Revenue Cycle Management exists to find where the cycle stalls, show why, and shorten it. Not by adding effort to a billing team that is already at capacity, but by removing the rework that never needed to exist.
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:
Patient collection is the hardest step in the cycle, and the easiest to lose: the best moment to collect from a patient is while they are still in front of you. Front-desk staff who are trained to take co-payments and balances at the time of service, working to a standard policy on discounts and financial expectations, prevent the backlog that everyone else downstream then has to chase.
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
Paid the first time it is submitted
The single biggest lever in the revenue cycle is first-pass acceptance, and almost all of it is decided at the front end — insurance verification, accurate patient information and precise coding — before a claim is ever transmitted.
Industry estimates commonly put first-submission denials somewhere between 5% and 10% of claims, and hold that the large majority of them are avoidable, because they originate in human or technical error rather than in clinical disagreement. A denied claim then travels between payer and provider for months while the data is corrected — time in which the work has been done and the money has not arrived.
Fewer claims sitting still
The current-claims picture improves through unglamorous things done consistently: reducing the rejection rate, shortening payment lag, tightening appointment scheduling, modernising submission and automating eligibility checks. Each is small. Together they decide days in accounts receivable.
Avoiding technical error and the suspicion of fraud matters twice over — once because reimbursement arrives sooner, and once because the cost of appealing claims and investigating errors is staff time that produces no care and no revenue.
Denials managed, not just recorded
Denial management is the difference between knowing a claim was refused and knowing why. The solution groups denials by cause, so the reason that is costing the most is visible rather than buried in a queue, and each one can be judged on whether it is worth appealing.
Fixing the cause is what stops the next hundred. Across NANO deployments, a first-pass acceptance rate of 99% has been reached where the process is run properly and an experienced team is behind it.
Improved net revenue to the practice
Higher percentage of clean claims
Reduced outstanding accounts receivables
Faster claims payment
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Related products
Products in the suite that work alongside this one.
More about this product
Standards and code sets
- ICD-10
- CPT
- HCPCS
How this works with the rest of the suite
- NANO CSS
The scrubber is the last gate a claim passes before it leaves — it catches the errors that would otherwise come back as a denial weeks later.
- NANO ECM
Once a claim is clean it still has to reach the payer in the format the payer expects; the eClaim engine is that transport.
- NANO AI CDI 360
First-pass acceptance is decided by documentation quality long before billing sees the claim, which is what documentation integrity fixes.
- NANO DRG
Under a classification-based contract the grouper determines what the episode is worth, so grouping and the revenue cycle answer the same question from two ends.
Frequently asked questions
What is revenue cycle management in healthcare?
- The administrative and clinical process that tracks a patient episode from the first appointment to the final payment for it. It covers eligibility, registration, coding, claim submission, denial follow-up and reconciliation. It is called a cycle because failures at one end show up as unpaid money at the other.
Why do most claims fail on first submission?
- Because the error was made before the claim was built. Industry estimates commonly put first-submission denials between 5% and 10% of claims, and hold that the large majority are avoidable, since they originate in human or technical error at registration, eligibility or coding rather than in a clinical dispute.
What is first-pass acceptance, and what is realistic?
- The share of claims a payer accepts without resubmission or appeal. It is the single most useful number in the revenue cycle because every point of it removes downstream work entirely rather than speeding it up. A first-pass acceptance rate of 99% has been reached in NANO deployments where the process is run properly and an experienced team is behind it.
Does this replace our billing team?
- No. It removes the rework — the resubmissions, the chasing, the re-keying — that a billing team at capacity spends most of its time on. The intent is to stop generating the work, not to process the same work faster with fewer people.
Where does the cycle usually stall?
- Rarely anywhere dramatic. Earned revenue tends to sit in accounts receivable getting older rather than disappearing: an eligibility check that was not run, an authorisation that was not obtained, a code that will not survive validation. Finding where it stalls and why is the first thing the system is for.