M2ComSys - BPO - RCM Services Profile - 2022.pptx

RCM services

1. RCM SERVICES [email protected]

2. We offer a range of services and products in IT and ITES M2ComSys was started in Las Vegas, USA in 1996 Revenue Cycle Management Services M2ComSys has been a leading provider in revenue cycle management services to medical practices. We partner with healthcare organizations to improve and accelerate reimbursements, prevent denials, arrest revenue leakage, and improve the patient experience. We leverage our team of industry veterans to ensure every aspect of the revenue cycle is processed in the most efficient and effective manner possible. We help you get your revenue cycle back on track, reducing costs and driving revenue.

3. TYPICAL WORK FLOW Revenue Cycle Management Services

4. M2ComSys was started in Las Vegas, USA in 1996 WORK HANDLED BY TEAM Revenue Cycle Management Services Eligibility/Benefit Verification Charge Entry Claims Adjudication Credit Balance Payment Posting AR follow-up (voice and non-voice) Denial Management An outline of the RCM disciplines we provide services in .

5. Eligibility/Benefit Verification Revenue Cycle Management Services The process of verifying benefits and eligibility of a patient(provided the benefits for the provider's specialty are available online on the insurance website) or telephonically via an IVR or a live representative. It is imperative at the time of scheduling to gather as much information about the patient's insurance carrier with which to verify benefits.

6. CHARGE ENTRY Revenue Cycle Management Services The process of capturing coded medical record of a patient into his account in the provider's software system is called as charge capture. The charges which are applied towards the procedure codes may be present on a form called ‘super bill’, wherein the provider circles the diagnosis or procedures rendered or they may be submitted by the coding team

7. M2ComSys was started in Las Vegas, USA in 1996 PAYMENT POSTING Revenue Cycle Management Services The process involves recording payment details as received from the insurance company (in the form of an EOB or an electronic remittance advice-ERA) and the patient. It is done in order to maintain a record of the payments received and also to work on the denials/pending claims if any and the necessary follow-up.

8. The purpose of AR team is to collect partly/underpaid pending or denied claims. The key to accounts receivables is follow-up which can be of two kinds; Insurance follow up which is to collect payment from the insurance company and Patient follow up which is to collect on the patient's responsibility. The process of AR begins on receipt of a denial or incorrectly/underpaid claim. It follows payment/cash posting and is usually done from the billing office. ACCOUNTS RECEIVABLE- VOICE AND NON VOICE FOLLOWUP Revenue Cycle Management Services

9. Inventor and Implementer of leading edge technology-enabled solutions DENIAL MANAGEMENT Revenue Cycle Management Services The team analyze the reasons for denials; set trends; do analysis and recommend the measures to be taken to avoid future denials caused due to errors committed at provider’s end. It is very imperative that all the departments at provider office do an accurate job while submitting the claims for processing in such a way that there are no rejections for any incorrect or additional information. We handle 2 types of denials mainly Rejections – When the denial is as a result of the patient’s fault or else additional info is required from the patient . Reviews - When the denial is because of the provider’s fault or additional info is needed from provider .

10. Leading players in medical, legal, business and general transcription services. In many cases, Insurance or patient might incorrectly pay more than the required amount to the provider. The provider is responsible to return/refund this additional amount to the respective party by either issuing a refund check or by adjusting this amount on the payment for a future claim. In some cases, the insurance might identify this overpayment and send a refund request letter to the provider with all relevant details. Or else they might deduct this amount in the future payments issues to the provider and add a note regarding this overpayment. We review the overpayment and validate the amounts in all scenarios and take necessary action as per the SOPs. Overpayments from the patient are usually adjusted toward their patient responsibility in future claims(if any). If the patient doesn’t have any future claims, then the amount will need to be refunded. CREDIT BALANCE Revenue Cycle Management Services

11. Inventor and Implementer of leading edge technology-enabled solutions We offer a range of services and products in IT and ITES Leading players in medical, legal, business and general transcription services. M2ComSys was started in Las Vegas, USA in 1996 CLAIMS ADJUDICATION Revenue Cycle Management Services The process in which an insurance company decided whether to pay, hold or deny the payment to the Provider. On behalf of the payer we performs 3 basic functions while processing the claims that we receive from the provider billing office . Pre Edit and Audit Claims Adjudication Communication of Decision