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info@zionrcm.com

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+1 501 301 4244

Medical Billing

Account Receivables

Account receivables play a vital role in Revenue Cycle Management. At ZIONRCM, we take great care in providing our RCM clients with personalized solutions to alleviate their financial worries.

Insurance Verification /Pre-Authorization

Insurance verification and pre-certification are 2 major issues in any practice that can affect the provider’s collection. Based on the data we identified, nearly 10% to 20% claims are denied for eligibility issues. Therefore, at ZIONRCM, we have implemented strategical approaches to verify the patient’s eligibility and financial benefits well before filing the claim to insurance.

Patient Demographics

Patient Demographics/Face Sheet is another vital factor that can affect submission and timely reimbursement due to incorrect data input. At ZIONRCM, we do 2 layers of quality checks to confirm the data is entered accurately in the practice management system.

Charge Entry

Accurate charge entry holds the key to successful claim filing. Our team has exemplary skills in capturing the charge in the practice management software, which undergoes stringent quality checks before the claim is filed.

Our team has exemplary capacity in keying the data accurately in the Practice Management, which will go through a stringent quality check before filing the claims.

Payment Posting

ZIONRCM has a team of highly trained professionals who will take up individual responsibility of payment posting for your business and deliver results surpassing your expectation. Payments which are received from the payer and patients are posted in the billing software ensuring no due payments are left behind.

Denial Management

Our Denial Management team establishes a trend between individual payer denials and common denials. ZIONRCM team works swiftly to determine the cause of denials, mitigating the risk of future denials, and ensuring the claims paid faster.

Medical Coding

Streamlining the medical coding process is crucial for healthcare organizations to ensure accurate billing, correct reimbursement, and compliance with regulatory adherence. ZIONRCM works diligently on this front to enhance the efficiency and effectiveness of the medical coding process:

Continuous Training and Education:

We provide ongoing training to medical coders to keep them updated on coding guidelines, regulations, and changes. This ensures our coders are well-informed about the latest coding updates and best practices in the industry.

Use of Technology:

Coding Software: We use advanced coding software that incorporates automation and artificial intelligence to assist coders in assigning accurate codes.
Computer-Assisted Coding (CAC): We utilize CAC systems to automate the coding process by suggesting codes based on clinical documentation, reducing manual effort and errors.

Regular Audits and Quality Checks:

We conduct regular internal and external audits to review coding accuracy. We identify and address discrepancies, coding errors, and areas for improvement.

Feedback Mechanism:

We have established a feedback loop between coders and auditors. We encourage open communication to discuss coding challenges, address queries, and provide constructive feedback for improvement period

Clear Documentation Standards:

We encourage healthcare providers to maintain clear and comprehensive documentation. Clear and detailed documentation makes it easier for coders to assign accurate codes.

Collaboration Between Coders and Clinicians:

We foster collaboration between medical coders and clinicians to enhance understanding of complex medical cases. Regular communication can help clarify coding-related queries and improve accuracy.

Specialized Training for Specific Specialties:

Our trainers provide specialized training for coders handling specific medical specialties. Different specialties may have unique coding requirements, and targeted training can improve accuracy in these areas

Implementation of Coding Guidelines:

We ensure that coders follow established coding guidelines, such as those provided by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA).

Investment in EHR Systems:

We utilize advanced Electronic Health Record (EHR) systems that integrate seamlessly with coding software. This integration streamlines the coding process by providing easy access to patient data and documentation.

Regular Communication with Payers:

We stay informed about changes in reimbursement policies and coding requirements from payers. Regular communication with payers helps ensure that codes align with reimbursement expectations.

Cross-Training Coders:

We rigorously cross-train coders in multiple specialties to increase flexibility and coverage. This helps in optimizing coding resources based on workload and demand.

Workflow Optimization:

We regularly evaluate and optimize the coding workflow to eliminate bottlenecks to look at ways to reduce processing time. Streamlining the workflow improves efficiency and reduces the likelihood of errors.

Coding Compliance Program:

We have established a coding compliance program to monitor and enforce adherence to coding guidelines. This program includes regular reviews, corrective actions, and education initiatives.

Engagement in External Coding Reviews:

We periodically engage external coding experts for independent reviews. External reviews provide a fresh perspective and identify areas for improvement that may be overlooked internally.

Encourage Certification and Credentialing:

We encourage our coders to pursue industry certifications and credentials, such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), to demonstrate their expertise and commitment to quality.

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Physician Credentialing

Our credentialing team has extensive experience in working closely with the payers and facilitate the process by reducing delays.

Provider/Payer Enrollment and Network Management

CAQH Profiles

Fee Schedule Review and Contract Re-negotiations

Specialties we handle

Ambulance

Ambulatory

Anesthesia

Cardiology

Dental

Dermatology

Durable Medical Equipment

ED/EM

ENT

Family Practice

Gastroenterology

HCC

Home health

Hospice

Internal Medicine

Pathology

Pediatrics

Physical Therapy

Podiatry

Radiation Oncology

Radiology

Rheumatology

Trauma

Urgent Care

Our PMS expertise

Allscripts

Aprima

Care360

CareTracker

CureMD

E-MDs

Exscribe

Greenway

Health

Kareo Billing

Medisoft

NextGen

Practice Fusion

Practicesuite