HMS uses advanced technology and employs certified medical coders to ensure accurate and timely claims submission, leading to faster reimbursements and reduced claim denials. They also provide comprehensive reporting and analytics to help healthcare providers track their financial performance and identify areas for improvement.
In addition to revenue cycle management, HMS offers healthcare providers electronic health record (EHR) and practice management solutions, helping them streamline their workflows and improve patient care.
The revenue cycle management process typically includes the following steps:
Patient Scheduling: The first step in the RCM process is scheduling appointments for patients. This involves verifying their insurance eligibility, demographic information, and insurance benefits.
Pre-authorization: Prior to providing medical services, healthcare providers need to ensure that the patient's insurance plan covers the necessary procedures. This step involves obtaining pre-authorization from the insurance company.
Patient Check-In: Once the patient arrives for their appointment, the front desk staff collects additional information, such as updated insurance information and co-payments.
Medical Coding: After the patient receives the medical services, the healthcare provider needs to document the procedures and diagnoses using medical codes. These codes are used to generate claims and bills.
Claim Submission: The medical codes and other billing information are used to create a claim, which is then submitted to the insurance company for payment.
Payment Posting: Once the insurance company pays the claim, the healthcare provider needs to post the payment in their billing system and record any adjustments or denials.
Accounts Receivable Follow-Up: If a claim is denied or rejected, the healthcare provider needs to follow up with the insurance company to resolve the issue. If a patient has a balance due, the provider needs to send statements and work with the patient to collect payment.
Overall, HMS is dedicated to helping healthcare providers succeed financially while providing high-quality patient care.