Revenue Cycle Management


Revenue Cycle Management

Our end-to-end services focus on the entire revenue cycle, including validating demographics and billing to a patient calling and reporting. With a proven track record in annual collections, Medspark RCM is a team of professional experts across the spectrum of healthcare.

At Medspark, we take care of Revenue Cycle Management needs by providing continuous support from the expertise.

You provide us the software platform and clearinghouse, and we do the rest.

How does the process go?

1. Collecting Patient Data

This process involves the patient registration appointment and patient on boarding which we will help us to keep track on each and every patient visits to office.

  • Patient registration
  • Appointment schedule
  • Patient on-boarding

2. Claims Preparation

  1. Insurance Verification

    Putting a solid insurance verification process in place will reduce the coverage denials in your practice, which makes medical billing practices more efficient and raising your overall cash flow.

    Updating the billing system with most recent insurance information of patient details such as member ID, group ID coverage period, and co-pay information and other benefits information.

    In case of issues regarding a patient eligibility, we inform the front office immediately.

  2. Eligibility & Benefits Check

    With the Medspark, insurance and eligibility verification is absolutely critical. Identifying patient responsibility upfront prior to the visit is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created i.e. delayed in payments, reworks, decreased patient satisfaction, increased errors, and non-payment.

3. Claims Submission

  1. Data Entry & Patient Demographics

    Following an appointment at the doctor’s office, we complete the Patient Demographic Entry by collecting and verifying the patient demographics received at the Patient visit. In the event that the patient is already registered in the medical billing system, new information is verified with the existing data and changes are swiftly updated.

  2. Implementation models:

    Receive Patient information from front office and billing offices.

    Verify the patient’s insurance information.

    Enter Patient information in the billing system

  3. Medical Record Documentation:

    It is important for the physician to record all medical services so the office can create an accurate medical bill to send to insurance providers or patients. This amounts to the patient’s current balance. This information is given to the patient as a receipt. The patient can then check out.

  4. Medical Coding:

    Our CPC, CCS, CMC, COC, CIC, CRC & AAPC certified Coders provide a Key step in the medical billing process, assigning appropriates codes by reviewing the documentation received from the Hospitals/ASC/physician’s office. We understand that medical coding is a vital process in medical billing. Proper coding is critical to reducing Insurance denials and increase revenue

  5. Charge Posting

    Our Medical Billing professionals enter charges based on standard medical billing rules pertaining to each specialty, insurance carrier and the location. The charges are created within the agreed time frame -generally 24 hours Turnaround Time. Our charge entry team is well trained to work with numerous medical billing software, packages like Medisoft, Misys Tiger, AdvancedMd, Caretracker, ECW, Kareo, centricity, Athena, Praticsmax,

    Charges are entered into the client’s medical billing system based on account specific rules.

    The pending or held documents are sent to the front office for clarification, on a pre-determined schedule.

    The final charges are audited by the Quality team and the clean claims are filed.

4. Claim Management

    • Payment Posting and Reconciliation

      At Medspark, payments received from patients and insurance companies are posted to the patients’ accounts in the client’s billing system. The posted payments are balanced against the deposit slips to ensure accuracy in payment. We also process electronic posting of payments into the billing software and ensure that the EOB (Explanation of Benefits) files are stored for future reference.

      The payment posting team also checks for any underpayment being made to the accounts and move the accounts to the Accounts Receivable team for reprocessing.

    • Denial Management

      Denial Management is critical in the process of medical billing. Our dedicated team of denial management experts execute a thorough analysis of the denied and underpaid claims to determine the reason behind the denial or underpayment.

      Corrective measures are taken on the basis of the analysis without any time delay, and the claims are re-submitted for acceptance of the insurance provider. After re-submission, the denial management team regularly follows up on the claims with the insurance provider to track status and expedites the payment.

    • Accounts Receivable Management And Insurance Follow Up

      Collection of Funds- Receivables, is a challenging task. medspark employee’s has proven professional and efficient strategies to recover receivables and also excels in converting aged AR receivables into collections by effective follow-up with insurance providers.

    • Appeal Process

      Integral to increasing client’s revenues, we spend much time and effort pursuing cases where a payment or denial has been made incorrectly, we challenge the insurance companies to receive the maximum reimbursement by submitting quality appeals to insurance at the first time.

    • Correspondence

      Claims workflows are driven by correspondence, which represents most communications with insurance and provider regarding claim activity. Claims departments are among the most visible departments in billing company, and correspondence represents one of the most important customer touch points.

      We in medspark dedicated staff who are expert in reviewing and taking effective action on the each correspondence received.

    • Secondary Insurance Billing:

      Billing patient secondary insurance is very important to collect complete eligible payment for patient and to make sure we are not leaving any revenue on table uncollected.

      In medspark we have dedicated experienced staff who works on secondary submission and AR collection.

    • Patient Calling:

      A dedicated patient calling team follow-up with patients to get missing patient information by sending emails, notices or making phone calls and also we take incoming calls from patient to resolve the billing related inquiry.