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Revenue Cycle Management (RCM) is a comprehensive process that ensures
healthcare providers are reimbursed efficiently for services rendered. It covers everything from patient registration, insurance verification, coding, billing, claims submission, to denial management. Effective RCM optimizes cash flow, reduces administrative costs, and improves overall financial health. By streamlining these processes, providers can focus more on patient care while ensuring timely and accurate payment for services. The goal is to minimize errors, prevent claim denials, and enhance revenue collection. RCM solutions often incorporate automation, data analytics, and a focus on compliance to ensures
efficiency and maximize reimbursements.

Medical billing and coding are essential components of the healthcare revenue cycle, ensuring that healthcare providers receive accurate and timely payment for services provided. Medical coders assign specific codes to diagnosis
Coding, procedures, and treatments based on clinical documentation, which is then used for billing purposes. Billing professionals submit claims to insurance companies, track payments, and follow up on outstanding claims. Accuracy is paramount in this process to prevent claim denials, reduce errors, and ensures
compliance with insurance and healthcare regulations. Efficient medical billing and coding ensures
timely reimbursements and minimize financial losses.

Claim management and Preventions are vital aspects of maintaining financial health for healthcare providers. Claim management involves the submission, tracking, and follow-up of insurance claims to ensures
accurate reimbursement for services rendered. Denial prevention focuses on identifying and addressing potential issues before claims are submitted, reducing the chances of denials. Key strategies include ensuring accurate coding, verifying patient insurance eligibility, and providing necessary documentation to support claims. Effective claims management and denial prevention lead to faster reimbursements, fewer administrative burdens, and improved cash flow for healthcare providers.

Front End – Revenue cycle Services:

Patient Scheduling and Appointment Management: Our team helps you manage patient appointments, ensuring timely scheduling and reducing no-shows.
Eligibility Verification: We verify patient insurance coverage, eligibility, and benefits, ensuring accurate billing and reducing claim denials.
Prior Authorization: Our team manages the prior authorization process, ensuring approvals are obtained for required services.
Patient Registration/Patient Demographics: We manage patient registration and demographic data, ensuring accurate billing and timely claims submission.
Point-of-Service Collections: Our team helps providing the support for an upfront collection supports cash flow and helps avoid bad debt, especially with high-deductible health plans.

Medical Coding Services: Our certified medical coders assign accurate codes to medical procedures, ensuring timely reimbursements and reducing claim denials.
Charge Entry & Charge Audit: We manage charge entry and audit processes, ensuring accurate billing and timely claims submission.
Claims Submission and Tracking: Claims are submitted to payers electronically, often facilitated by a clearinghouse that formats the claims for compliance. Ongoing tracking of submitted claims is vital to determine their status, ensuring that any issues are addressed promptly
Revenue Integrity: We help ensures
revenue integrity by conducting regular audits and reviews of billing processes and claims submissions.
Medical Coding Audit: Our team performs medical coding audits to identify and rectify coding errors, ensuring timely reimbursements and reducing claim denials.

Clinical Documentation Improvement: We help improve clinical documentation to support accurate coding, reduce claim denials, and ensures
compliance with regulations

Remittance Processing: We process remittance advice and EOBs, ensuring timely and accurate payment posting.
Accounts Receivable: Our team manages accounts receivable, ensuring timely follow-up and collections.
Denial Management: We manage claim denials and appeals, ensuring maximum reimbursement and reducing revenue loss.
Credit Balance: We manage credit balance accounts, ensuring timely and accurate refunds to avoid interest charges.
Patient billing and collections: We manage patient statements, sending invoices, and managing patient payments and collections for services not covered by insurance or for patient responsibility portions such as deductibles, co-pays, and co-insurance.

Payer services are designed to streamline the relationship between healthcare providers and insurance companies, ensuring accurate and timely reimbursement for medical services. These services help manage the complexity of insurance claims, from claim submission to payment processing. They include eligibility verification, benefit coordination, billing, and follow-ups to prevent claim denials. By offering managed payer services, healthcare providers can focus on patient care while ensuring they meet payer requirements for reimbursement. Efficient payer services also help reduce administrative burdens, improve cash flow, and maintain compliance with payer contracts and healthcare regulations.

Credentialing and provider enrollment are critical processes in the healthcare industry that ensures
healthcare professionals meet required standards and are eligible to provide services under insurance contracts. Credentialing involves verifying a provider’s qualifications, including education, training, licensure, and experience, to ensures
they meet legal and contractual requirements. Provider enrollment is the process of getting providers approved by insurance companies to participate in their networks. These processes are vital for ensuring compliance, improving patient safety, and enabling providers to receive reimbursement for services. Efficient credentialing and enrollment reduce delays and ensures
providers can offer services without interruptions.

Patient engagement and customer support play a crucial role in improving healthcare outcomes and ensuring patient satisfaction. Patient engagement involves actively involving patients in their own care, including appointment scheduling, treatment plans, and ongoing communication. Customer support focuses on addressing patient inquiries, handling concerns, and offering assistance with billing, insurance, or other non-medical needs. Both areas contribute to building trust between healthcare providers and patients, fostering better communication, and enhancing overall care experiences. Effective patient engagement and customer support not only improve patient satisfaction but also help reduce no-shows, enhance compliance, and increase loyalty to the healthcare provider.

Empowering People, Elevating Businesses
At OptiRev Solutions Pvt Ltd, we specialize in staffing solutions that drive growth, enhance workforce efficiency, and build thriving workplace cultures. Whether you need support in talent acquisition, workforce planning, or contract staffing, we provide tailored services to ensures
the right people power your business success.

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