Legion Healthcare Solutions

Revenue Cycle Management

Revenue Cycle Management (RCM) is a complete process between the first interaction with the patient to final payment of the balance. Revenue Cycle Management (RCM) over the years has gone from being administrative to a part of value-based care. Today, RCM is defined as “all administrative and clinical patient data that lead to capture, management, and collection of all revenue.”

Errors in revenue cycle management can lead to delayed or part or no reimbursement. With changing healthcare scenarios, most providers hire a revenue cycle management services company to deal with complex and regulatory oversight. RCM service company can handle the process 24/7 with certified and specialized agents and RCM technology.

According to a survey, Account Receivables in 2014, the average physician practice took 18 days to generate a claim after the date of service and had a denial rate of 11%.

Step 1
Eligibility and Benefits Check

Eligibility and benefits check to get patients' digital ID along with patient information. Here a complete benefits information can be discussed with the patient, on the basis of copay, coinsurance, and deductible.

Step 2
Patient Demography and Data Entry

All information related to patient demography is important; it provides a complete view to providers related to patients' insurance claim payment.

Step 3
Referral and Prior Authorization

A referral is when a provider or practitioner recommends another specialized provider or practitioner for a specific condition. During this, the reimbursement is usually shared.

Prior Authorization is a process of reviewing provider/practitioner referral orders to ensure medical necessity and insurance plans for the requested care prior to the care service provided by the provider/ practitioner.

Step 4
Medical Coding

Our certified team of medical coders work on converting patient information, diagnosis and procedures into billable codes. In this step Legion medical billing service provides a QA team to provide maximum reimbursement.

Step 5
Charge Entry

The created patient account is assigned with an appropriate value before reimbursement as per coding and appropriate fee schedule. The charge entry will determine the providers reimbursement.

Step 6
Claim Submission

Claim submission determines the amount of reimbursement that a healthcare provider will receive after the insurance company clears the dues.

Step 7
Payment Posting

It's the first line where both payer and provider discuss their information. Information from EOBs and ERAs is matching the payments. Payment Posting is the most important step where providers can earn profit.

Step 8
Denial Management

Denied claims will not be processed as they have not been received/accepted by payer. Such denied claims will be resubmitted when the errors are corrected, this causes a reduction in cash flow.

Step 9
Account Receivable (AR)

AR represents the amount any provider will receive for the services that have been provided and billed. Any payment from patients, payers, or co-payers is considered as AR. Legion keeps monitoring each AR in the aging bucket for every month significantly improves the reimbursement.

Step 10
Claim Appeal

Claim appeal is a process by which usually the patient or provider request to the insurance company to pay the amount posted during charge entry. The appeal on any claim can happen if the claim has been rejected or denied.

Revenue Cycle Management (RCM)

We have over a team of 100+ resources working across various steps in RCM process, and they are regularly trained to keep the updated with changing reimbursement process. Working with different providers in tandem can be difficult hence we use technology to keep track of claims and AR days.

To get free consulation on RCM process, do contact us on:

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