REVENUE CYCLE MANAGEMENT
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Charge Entry Process
Charges and Patient demographics, including insurance information, are entered into the billing system by GMM staff.
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Claims Submission Process
Claims are submitted to the payor via the payors preferred transmission method (electronically through clearinghouse or direct to payor, etc.) Claims are scrubbed by Payor Path Clearinghouse to ensure claim has correct/complete information so that it may be processed by the payor as efficiently as possible.
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Receipt Entry Process
Received payments are posted into the billing system and checked against the physicians contracted rates with the applicable payor. All payments received that are not paid at the correct contracted rate are addressed immediately, and monitored to ensure the payor remits additional payment.
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Audit Process
Beginning 14 days after claim submission, all outstanding claims are called on and worked up as appropriate until correct payment is received.
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Patient Collection Process
All patient balances are worked until either the account balance is zero or in house collection processes have been completed without account resolution, in which case the account is outsourced to an external collection agency upon approval from Client.
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Credit Balances
As important as it is to work each patient account until it is paid, it is also vitally important to address and manage credit balances. All credit balances are addressed on a monthly basis.
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Correspondence/Denial Process
All denials are worked by the Correspondence Specialist. Denials are monitored and tracked to ensure proper reprocessing and identification of denial trends.
Global Medical Management maintains a staffing ratio level to ensure every part of the revenue cycle is addressed every month. We also believe educating the physician and the physician’s staff are crucial to optimizing reimbursement and ensuring regulatory and contractual compliance.
