Consulting Solutions
Our consultants are leaders and subject matter experts. RCM Physicians Services, LLC, offers comprehensive consulting solutions that will propel you to where you want to be. We provide transformational experience and expertise, fully customized revenue cycle management, credentialing, compliance, and billing consulting services. RCM provides expertise and resources to guide your healthcare companies in addressing operational, clinical, and financial challenges.
Our team of consultants can help your physician practices, health care providers, and non-medical home care organizations achieve improvements in areas that drive effectiveness, outcome excellence, and reimbursement optimization. We support your unique agency needs and help attain best practices for you.
Pursuing Possibilities in the fast-paced Healthcare Market
Healthcare is changing rapidly, and we have walked in your shoes and know exactly the risks and opportunities that you are presented with each day. As our relationship continues to evolve, we help our clients address and solve both key strategic and tactical challenges across your organization with practical solutions grounded in experience.
Consulting Services
- Practice assessment and analysis
- Revenue cycle management optimization
- Compliance and regulatory review
- Strategic planning and development
Credentialing Services
- Provider credentialing and enrollment
- Credentialing and re-credentialing support
- Credentialing verification and primary source verification
Billing Services
- Medical billing and claims processing
- Revenue cycle management and accounting
- Denial management and appeals
RCM Physician Services, LLC, Consulting Services
RCM Physician Services, consultants, are knowledgeable and have the credibility and the experience to support your organization. In today's society, healthcare consulting services play a crucial role in supporting healthcare agencies, ensuring they provide quality care while navigating operational, clinical, and financial challenges. Our role at RCM is to assist your healthcare-related organizations to run your businesses effectively.
At RCM our duties may include finding methods to reduce costs, increase revenue, and maintain customer and patient satisfaction. Here are some key aspects of RCM consulting services:
- Analyzing Processes: We examine existing processes within your organization. We provide professional advice and guidance on how to make improvements, streamline workflows, and enhance efficiency.
- Problem Solving: We work closely with administrators and other high-level executives to identify problem areas within your organization. We offer optimal solutions to address these issues.
- Cost Reduction: A significant part of our job involves finding ways to help you reduce costs while maintaining quality patient care. This includes optimizing resource utilization and operational efficiency.
- Revenue Enhancement: We explore strategies to increase revenue by analyzing financial data, billing processes, and reimbursement systems to identify opportunities for improvement.
- Healthcare Policies and Compliance: We stay informed about healthcare policies, regulations, and industry trends to help provide informed recommendations to organizations.
- Customized Solutions: At RCM we are aware that each organization’s needs are unique. Hence, we tailor advice and solutions to fit the specific context and challenges faced by the organization.
Resources
More information on RCM Responsibilities here.
RCM Physician Services, LLC, Consulting Responsibilities
Business Planning: - Assisting with the development of a comprehensive business plan, including market analysis, financial projections, and operational plans. - Identifying and assessing potential risks and developing strategies to mitigate them.
Licensure and Certification: - Assisting with obtaining necessary licenses and certifications, such as Medicare and Medicaid certifications. - Ensuring compliance with all relevant regulations and standards, such as HIPAA and OSHA.
Marketing and Sales: - Developing a marketing and sales strategy to attract and retain patients. - Assisting with the creation of marketing materials, such as brochures and websites when requested.
Operations Management: - Assist with the development of policies and procedures for clinical and administrative operations. (Contracted services) - Identifying and procuring necessary equipment and supplies.
Human Resources: - Assisting with the recruitment and hiring of qualified staff, including nurses, aides, and administrative personnel: Developing employee policies and procedures, such as those related to hiring, training, and performance evaluations.
Financial Management: - Assisting with the development of a financial plan, including budgeting and forecasting. Identifying and securing funding sources, such as private investors or loans.
Legal and Regulatory Compliance: - Facilitating compliance with all relevant laws and regulations, such as those related to patient privacy and employee safety. - Reviewing and drafting contracts with payers, vendors, and other business partners.
Risk Management: - Identifying and assessing potential risks to the agency, such as liability and reputational risks. - Developing strategies to mitigate these risks, such as obtaining appropriate insurance coverage and implementing risk management policies.
Quality Improvement: - Assisting with the development of a quality improvement program to ensure that the agency is providing high-quality care to patients.
RCM Physician Services, LLC Credential Services
RCM Credentialing provides comprehensive medical credentialing for all healthcare providers who are eligible for credentialing with Medicare, Medicaid, or commercial insurance carriers.
The health care provider will have a dedicated medical credentialing consultant who will ensure that all essential documentation is collected and processed per each payer's needs. We will also help you with developing the necessary documents.
Medical credentialing enables healthcare providers to utilize the patient’s insurance to pay for medical services performed. To be successful, healthcare providers must be credentialed with most payers depending upon the geographical area. Not having medical credentials may result in losing patients to other healthcare providers.
RCM’s Provider Credentialing Process
- Gathering credential documents
- Credential documents verification
- Suggest updating or how to obtain certain missing documents
- Payer application evaluation
- Application submission to payers
- Follow up with payers until the applications are approved
- Maintain provider data and CAQH profile
Credentialing Status
- Weekly Status reports during the credentialing process
- A dedicated credentialing coordinator to assist throughout the process
- Prior notifications of expired malpractice insurance, licenses, DEA, Board Certification, etc
- Prior notification on hospital and facility re-credentialing.
Do not Fear the credentialing process!
The credentialing process can be time-consuming, particularly when in-house resources are stretched thin. Schedule a call today to learn more about our credentialing process and how we can support your practice.
More information on RCM Responsibilities here.
RCM Physician Services, LLC, Credentialing Responsibilities
- Provider Credentialing: - Collecting and verifying provider credentials, such as education, training, and licensure. - Ensuring compliance with credential standards and regulations.
- Credentialing and Re-credentialing: - Managing the credentialing and re-credentialing process for providers. - Ensuring that providers meet the agency's credentialing standards and regulatory requirements.
- Credentialing Verification: - Verifying the credentials of providers, including primary source verification. - Ensuring the accuracy and completeness of provider information.
- Credentialing Committee: - Coordinating the activities of the credentialing committee, including reviewing and approving provider applications. - Ensuring compliance with credentialing policies and procedures.
- Credentialing Software Management: - Managing the agency's credentialing software, including data entry, reporting, and analytics. - Ensuring the accuracy and completeness of provider data.
- Credentialing and Privileging: - Managing the credentialing and privileging process for providers, including reviewing and approving applications. - Ensuring compliance with credentialing and privileging policies and procedures.
- Credentialing Maintenance: - Maintaining accurate and up-to-date provider information. - Ensuring compliance with credentialing maintenance requirements.
- Credentialing Reporting: Generating reports on credentialing metrics, such as provider applications and approvals. - Using data to identify trends and opportunities for improvement.
- Credentialing Compliance: - Ensuring compliance with credentialing regulations and standards, such as those. related to Medicare and Medicaid. - Keeping up to date with changes in regulations and guidelines.
- Credentialing Education and Training: - Providing education and training to providers on credentialing policies and procedures. - Ensuring that providers have a comprehensive understanding of the credentialing process.
RCM Physician Services, LLC Billing & Revenue Management Services
At RCM, billing and revenue management encompasses the processes, technologies, and methodologies your organization employs to manage its billing cycles.
Revenue Cycle Management (RCM)
RCM is crucial in healthcare organizations. It begins when a patient schedules an appointment and concludes when the account balance is resolved through insurance payments, contractual adjustments, write-offs, or patient payments. The goal of RCM is to strengthen revenue by minimizing claim denials, reducing days in accounts receivable, and increasing collections.
Key steps in an effective revenue cycle include appointment scheduling, registration, charge capture for services, billing, denial management, and accounts receivable follow-up.
Billing and Revenue Management (BRM) involves managing financial operations related to billing and collecting revenue for products and services sold. BRM plays a pivotal role in maintaining financial stability and compliance across various industries. At RCM Services, we ensure accurate revenue flow and operational efficiency.
Why RCM Physician Services?
With over 30 years of experience in medical billing and credentialing services, RCM will support your practice by:
- Increase the practice revenue by a minimum of 10% in the first 30 days
- Convert paper EOBs & checks to electronic in the first 30 days
- Insurance in network list to avoid pre-auth & pre-cert denials
- Appeal denied claims to reverse the payer decision
- MIPS consulting & certified coders
- Incoming patient balance calls answering
- 96% of claims collected in the first 20 days
- Denied claims are followed up within 24 hrs
- Clearing house & insurance rejections are followed up in 24 hrs
- Charges & ERAs posted within 8 hours
- Customized reports
More information on RCM Responsibilities here.
RCM Physician, LLC, Services
Billing & Revenue Management Responsibilities
- Patient Information Management: - Collecting and verifying patient demographic and insurance information. - Ensuring accuracy and completeness of patient information.
- Billing and Coding: - Coding and billing for services provided to patients using appropriate CPT and ICD-10 codes. - Ensuring compliance with coding guidelines and regulations.
- Claims Submission: - Submit claims to payers, including Medicare, Medicaid, and commercial insurance plans. - Ensuring timely submission of claims.
- Claims Tracking and Follow-Up: - Tracking the status of claims and following up with payers as needed. - Identifying and resolving any issues or denials related to claims.
- Payment Posting and Appeals: - Posting payments and credits to patient accounts. - Handling appeals and disputes related to claims denials or payments.
- Revenue Cycle Management: - Overseeing the entire revenue cycle process, from billing to payment. - Identifying and addressing any issues or inefficiencies in the revenue cycle process.
- Patient Billing and Payment: - Generating patient bills and collecting payments. - Handling patient payment plans and financial assistance programs.
- Insurance Verification and Authorization: Verifying insurance coverage and obtaining authorization for services. - Ensuring compliance with insurance verification and authorization regulations.
- Billing and Reimbursement Compliance: - Ensuring compliance with billing and reimbursement regulations, such as those related to Medicare and Medicaid.
- Keeping up to date with changes in regulations and guidelines.
- Reporting and Analytics: - Generating reports and analytics on billing and revenue cycle metrics. - Using data to identify trends and opportunities for improvement.
Service Delivery Process and Approach
Client Onboarding
- Initial consultation and assessment
- Credentialing and enrollment
- Setup and implementation of billing and credentialing software
- Ongoing support and training
Ongoing Support and Maintenance
- Regular review and assessment of revenue cycle management processes
- Credentialing and billing software support and maintenance
- Ad-hoc reporting and data analysis
- Ongoing training and education for clients and staff
Service Level Agreements (SLAs)
- Response time for client inquiries and support requests
- Timeliness and accuracy of billing and credentialing services
- Uptime and availability of billing and credentialing software