RCM-Revenue Cycle Management Services

Ophthalmology

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Services

Credentialing &Contracting

If you want to start your own practice and make it successful, you need to know what your patients want and expect from you. One of the things they expect is that you will take their insurance plan. That’s why credentialing is very important for any practice. It means that you have to be accurate and careful to make sure your patients are safe, you get paid quickly, and your operations run smoothly. Credentialing and enrollment used to be ignored as part of the healthcare administration process. But now they are essential because they affect how compliant and profitable your practice is.

In the current healthcare system, if you don’t do credentialing right, you might not get paid for the services you provide. Or worse, you might face legal problems for breaking the rules, which could cost you money and even land you in jail.

One way to get more patients is to join insurance provider panels. This means that you will be listed as a provider in the network of the insurance company. It also means that you can get paid directly from the insurance company. But before you can sign a contract with an insurance company, you have to go through credentialing. Credentialing is the process of collecting and verifying your professional records.

Credentialing for medical billing can be hard, long, and boring. It’s not easy to do it by yourself, and it usually takes more time and money than hiring a professional who knows how to do it and can speak for you. Insurance companies need time to check your records and process your applications in the order they get them. So, this is a situation where you have to hurry up and wait. And it can be very annoying and distracting for medical professionals who should focus on their main skills instead of doing something they are not trained for.

But don’t worry, we can help you with that. You can enjoy doing what you like while we take care of everything for you.

HOW WE WORK

01
DATA COLLECTION

In this, we collect all the credentials of the practice and the doctor to start the credentialing process. To start the credentialing process, it is necessary that the credentials collection should be completed and timely.

02
APPLICATION SUBMISSION

When the data collection gets completed, we start the application submission. We submit the requests to all the commercial and federal insurances within 2-3 business days.

03
TIMELY FOLLOW UP

Timely follow up is the major component to get approve a request. Our experienced team do follow up of each request with the concerned insurance company one time within 15 days.

04
ACTIVE COMMUNICATION

We have the active communications with doctors as well as with insurances. We provide all the requested information timely to provider and insurances as per request.

05
MONTHLY MEETING

We have the monthly meeting on zoom with our clients to discuss and explain the monthly reports. TYPES OF CREDENTIALING SERVICES
1) Initial Credentialing and contracting
2) Adding/Removal of a Practitioner
3) Demographic Update
4) Annual Maintenance
5) Contracts Negotiation

Types of Credentialing Services

1)Initial Credentialing and contracting
2) Adding/Removal of a Practitioner
3) Demographic Update
4) Annual Maintenance
5) Contracts Negotiation

EHR, PM, Clearing House Setup

PlusMed is flexible, we can work with the healthcare billing software that you already have in your practice. If you don’t have any software, you can pick EHR, Practice Mate and Clearinghouse of your preference. We can also handle the paperwork required for EHR, PM and Clearinghouse enrollment on your behalf to share the paperwork load.We know how much you hate paperwork. After a busy day, the last thing you want is a pile of forms to complete. We assign a team of professionals who are skilled in filling out the forms and applications. It might seem like an easy task, but it needs a keen eye for detail as a missing number can cause big delays.

EDI, ERA &EFT Enrollments

Official paperwork is the curse of our lives. After a long day, the last thing you need is a pile of forms to fill out. A large proportion of situations involving payment delays and claim rejections are the result of incorrect enrollment. When we onboard your practice, we ensure that your EDI, ERA, and EFT are properly configured.

Key Benefits of EDI, ERA & EFT Enrollments

Medical Billing Services

01
Verification of Eligibility and Benefits

We check the insurance eligibility of each patient to help you speed up your process, lower your outstanding payments, and prevent rejections.

2
Charge entry

Get paid quickly as our thorough and accurate charge entry process guarantees claim submission without any rejection.

3
Claims Scrubbing

Our excellent claim scrubbing ensures that claims are submitted without any mistakes and flaws, leading to quicker payment and fewer rejections.

5
AR Follow Up

our professionals adopt a Flawless Claim Submission method to minimize rejections. Moreover, we maintain a consistent follow-up on claims. Additionally, enhance cash flow, boost efficiency, and lower revenue losses

7
Payment Posting

We post ERAs and EOBs promptly as our skilled team checks each claim for suitable payment, while our A/R team tracks any disputed or denied claims.

4
Electronic Claim Submission

Our excellent claim validation ensures that claims are submitted without any mistakes and flaws, leading to quicker payment and fewer rejections.

6
Rejections and Denial Management

Medical Billing denial and rejections management team experts who:
*Find out the reason of every rejected or denied claim
* Concentrate on resolving the problem
* Resubmit the claim to the insurance companies
* Make appeals where needed

8
Patient Statement

We provide clear, simple, understandable patient statements that are more likely to be paid promptly.

10
Reporting

We provide data reports in a simple-to-read format on a weekly and monthly basis, giving you extensive insights into your payments and charges.

Medical Billing Audit

The Medical Billing Audit process is a good way to see the whole picture when it comes to your medical practice and its overall performance. It allows you to fix all revenue losses and contribute to better revenue cycle management. However, for medical practices, these medical billing audit templates have to be outsourced to those RCM billing companies that are fully HIPAA compliant and ensure the protection of Private Healthcare Information [PHI]. As a result, your medical practice can benefit from the audit while staying confident regarding the security of your patient’s healthcare information.

Key Benefits of Medical billing audit

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