Making RCM more TRANSPARENT and Efficient
We provide transparent data, relevant reporting and detailed follow up, which allows for reduced errors, maximization of revenue and provides a clear picture of the financial health of your organization.
Revenue Cycle Management (RCM) is not billing. Billing is the process of filing claims with insurance carriers and following up on those claims with the funding sources to ensure payment. RCM does include billing and claims management, however, it also includes partnership with clinical staff, documentation improvement, process improvement, denial management, handling patient balances and real-time financial reporting.
As a result, organizations must focus more effort on efficient revenue cycle practices that leverage technology and collaboration that allow employees to work by exception.
Health care providers must control operating cost while providing high-quality care.
- Enrollment Services
- Charge Capture
- Medical Coding
- Claims Submission
- Payment Posting
- Accounts Receivable
Catalyst RCM understands the importance of enrollment services with your major payers for claims and electronic data interchange. Our team will assist with your enrollment for all major payers to ensure that electronic transactions will occur for claims processing, receipt of remittances and eligibility verification. In addition, Catalyst RCM can assist with enrollment with new payers when applying to become a network provider.
Ineligible insurance is the most common reason for claim rejections and denials by payers. In addition to determining insurance, certain services provided will require pre-authorization from the payer. Both of these tasks are a time consuming process that can be overlooked if there is not a dedicated resource assigned to them. At Catalyst RCM, we offer both insurance verification and pre-authorization services to our clients as we understand the importance of these tasks to avoid claim denials and reduced cash flow.
According to a recent publication by Sage Growth Partners, they surveyed 104 leaders in a supervisory role in revenue cycle at healthcare organizations across the United States noting 78% of these leaders agree charge capture is the key to success. Unfortunately, this essential part of the healthcare revenue cycle is only discussed once a month or less. Not billing for services rendered to patients is resulting in a significant financial loss to organizations across the nation. Catalyst RCM can help keep charge capture at the forefront of the revenue cycle by reviewing claims and verifying claims are not being under or over-coded which can also cause future revenue loss when payers retro audit claims and recoup for improper billing. We work with our clients to make sure they get paid for all services rendered and to minimize the impact on patients.
For consistent and accurate data, compliance with coding guidelines is integral in reporting proper analytics used to make financial decisions in this ever-changing market. Catalyst RCM verifies claims go out clean to insurance companies, so they get paid right the first time. We make sure all proper coding guidelines have been followed which include: National Correct Coding Initiative (NCCI) Edits, Medically Unlikely Edits (MUE) and CPT to ICD-10 crosswalk relationships. Catalyst RCM also reviews carrier policies to ensure our clients understand any major changes which can affect treatment protocols and future revenue.
At Catalyst RCM, our billers understand the nuances that come with different insurance plans such as Fee-For-Service, Health Maintenance Organizations (HMOs), Point-of-Service (POS) and Preferred Provider Organizations (PPO). Our billers have experience with laboratory, long-term acute care, ambulatory surgical centers, physician practices and ancillary services billing.
Payment posting is a key process within the revenue cycle that allows for the determination of underpayments. At Catalyst, we understand the importance of line item posting to ensure that all services provided are reimbursed in accordance with the payer contract.
At Catalyst we understand the importance of accounts receivable management which is why we assign accounts to members of our accounts receivable (AR) team after the claim is submitted. The AR life cycle does not start when the claim is denied, it starts the day the claim is submitted which is why we have team members dedicated to checking claim receipt and status after the claim is submitted. In addition to internal AR workflows, Catalyst team members provide regular communication to clients to ensure they understand their AR and are able to resolve any potential issues that are impacting cash flow.
Catalyst RCM analytics were created as a business analytics and workflow tool that integrates with major EMRs to assist our clients streamline and automate their revenue cycle. Catalyst RCM analytics provide our clients transparency into their data and key trending such as average reimbursement per sample type & payer, actual reimbursement compared to expected, net revenue per patient day, payer mix and denial trends.