SiriNiti's comprehensive solutions in Revenue Cycle Management (RCM) increase and streamline compliance while saving your money. Our proven capabilities accelerate your revenue cycle to increase your productivity, speed payments, decrease costs and improve patient service. In addition, our experienced health-care team analyses Explanation of Benefits (EOBs) and claims and acts immediately to recover the due amount. All of which means you can focus on your core business - providing better health care.
Below is a staged representation of our Revenue Cycle Management and Billing services.
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Eligibility Verification:
Over 50% of all health care claims are denied because a patient is not eligible for services billed to the insurer. Often, a patient would be ineligible to claim for benefits because the policy has been terminated or modified. Unfortunately Eligibility Verification is one of the most neglected elements in the revenue cycle. SiriNiti can help practices significantly increase their revenue by reducing the ineligibility.
Numerous problems are created due to lack of proper eligibility and benefit verification. These include delayed payments, increased errors, non-payment of claims and patient dissatisfaction. To avoid these problems, SiriNiti provides a remotely hosted solution for Hospitals and Medical Practices. The solution consists of SiriNiti deploying expert staff that can be accessed via a toll free number working remotely, with an objective of delivering high quality cost effective patient insurance eligibility and related services.
Medical Coding:
Promantra follows the coding process through a structured methodology which has worked well for our clients. Our coding services will help our clients to experience an increase in returns and a reduction in the number of denials as we comply with the ICD-10-CM Official Guidelines for Coding and Reporting, CCI (Correct Coding Initiatives) and LMRP(Local Medical Review Policies).Updated ICD-9-CM, CPT, and HCPCS Level II code books are used by all Promantra coding professionals. Updated encoder software, including the appropriate version of the NCCI edits is available to all coders.
Charge Entry:
Charge entry is carried by gathering all charge documents from all departments, within the facility that have provided services to patients. SiriNiti Charge Entry team gathers all the information required for charge capture from the client file, patient demographic file and the charge ticket/sheet.
Payment Posting:
When payments are received, the appropriate payments and insurance carriers are posted to the patient accounts along with any patient payments until the balance has been satisfied. SiriNiti carefully checks EOB / Private Checks or scanned credit card statements are used to capture details like Patient Account Number / Patient Control Number, Patient Name, Date of Service, Procedure Code, Billed Amount, Allowed Amount, Adjusted Amount, Paid Amount, Deductibles and Denial Details, Refunds, Offsets and Reconciliation.
Billing:
After final payment has been made by the insurance carries, the accounts are assigned to representatives, to invoice patients, and notify the patients with follow up reminders, of their responsibility to pay and arrangements made for payment.
AR Follow-up:
With highly skilled associates and cutting edge technology, SiriNiti can enhance Provider’s revenue and sequentially increase your organization’s bottom line by managing charge entry, payment processing, reducing days in A/R, claims submission improving collection ratio and increase the probability of payment through timely follow-up. We have Certified Billers who are heading our team with a minimum of 8 years experience and a team’s average experience of 5 years. Based on our findings, we have aligned our resources and our delivery model to maximize revenues for practices
Denial Management:
At SiriNiti, our Denial management Process tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. With this powerful combination in hand, the Practice / Provider of medical service can then utilize claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims.
Long Term Care RCM & Services
SiriNiti’s LTC-RCM billing services expedites Long Term Care organizations claims and reimbursement collection activities for services performed. We accelerate your Revenue Cycle velocity by systematically working on different phases of Resident Cycle which includes admissions, insurance authentication, charge processing, billing, follow ups for collections, payment posting and bad debt management.
Our RCM services delivered on our proprietary GeroPro platform helps LTC organizations to beneficently appraise managed care contracts (medicare & medicaid), authenticate reimbursements, provide systematic resident estimates and fundamentally augment financial results by; reduction in AR age, bad debts , denials and cost of collections.
SiriNiti LTC RCM & Billing Services include:
- We bill for Medicare, Medicaid, Insurance, and Co-Insurance for third party or private payers.
- Opportunities for improvements to comply with Medicare and other Payor requirements.
- Act upon primary, co-insurance and deductible claims.
- Invigorate Claims re-submission for denials or incorrect payment of Medicare, Medicaid or other third-party Payor claims.
- Monitor billing collections and suggesting amounts to be written off on Payor-regulated timelines.
- MIS for collection buckets and pipelines, including payments and or suggested adjustments.
