Revenue Cycle Management is a complex system of functions. Which is why it makes sense for a company like iHealth Solutions to manage it for you. Our RCM solutions are customized to improve your profits, allow you to see more patients and relieve you of uncomfortable “follow ups” on payment.

We process standard files electronically and review and follow up on all denied claims – using established procedures to resolve the latter. Our team of specialists contact payers and aggressively work each outstanding claim. Detailed reports are generated by payer to identify unpaid claims. Our follow up process includes submitting claims to secondary insurers, re-submission based on corrected information and documentation, and transferring balances to patients for resolution.

ICD-9 coding is becoming obsolete. Our coding team is well-versed in ICD-10 which has nearly 10x as many codes as the existing system – from 17,000 to a whopping 155,000. This improves billing accuracy. Our team validates superbills to prevent any denials due to ‘up-coding’ or ‘down-coding’, and audits the coded charge sheets to ensure that they have accurate CPT codes and comply with CMS, AMA and government payer regulations. We guarantee a minimum accuracy of 95%.

We follow up on receivables by phone, e-mail, and online to get the status of each claim submitted to the insurance company. We analyze claims over 30, 60, 90, 120 and more days and work down from the age of the claim. Through detailed reporting, resubmission of claims and timely submission of secondary claims, we improve cash flow and reduce days in AR.

We identify underpayments by payers at the individual claim level. We then follow up aggressively with payers to pay their agreed rates. We do not give up on zero balance accounts that have been closed by the facility. Instead, we provide collection services towards old accounts receivables, which include follow-up on underpaid claims, understanding reasons for underpayment, addressing issues and recovering revenues from payer.

Leveraging innovative technology, we are able to streamline the patient insurance eligibility verification process. Using electronic interfaces, our solution automatically connects to a health plan to retrieve information like eligibility dates, co-pay and deductible amounts, excluded services, maximum amount of benefits and other desired information. At the time an appointment is scheduled, your staff can verify insurance over the phone with the insurance company or online.

We have the resources to handle the high volume of incoming customer service telephone calls generated by itemized bills for outstanding charges sent to patients – particularly those patients who refuse to accept the responsibility of payment. Our approach is to first try to satisfy patients with answers and explanations as to why they are genuinely responsible for the payment. We do the fact finding with the insurance companies to interact with the patient effectively, freeing your staff up for other revenue generating tasks.