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 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/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.
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.
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.
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.
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:
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.
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.
We conduct regular internal and external audits to review coding accuracy. We identify and address discrepancies, coding errors, and areas for improvement.
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
We encourage healthcare providers to maintain clear and comprehensive documentation. Clear and detailed documentation makes it easier for coders to assign accurate codes.
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.
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
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).
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.
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.
We rigorously cross-train coders in multiple specialties to increase flexibility and coverage. This helps in optimizing coding resources based on workload and demand.
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.
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.
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.
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.
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
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
Allscripts
Aprima
Care360
CareTracker
CureMD
E-MDs
Exscribe
Greenway
Health
Kareo Billing
Medisoft
NextGen
Practice Fusion
Practicesuite