• RCM process involves a series of steps that lead to providers getting paid on time from the insurance companies for the services they have provided to patients. For this process to be effective and efficient, each step has to be managed efficiently, starting with front-end tasks like appointment scheduling and insurance eligibility verification with the help of professional medical coders and clinical coders. Designing and implementing onsite-services such as a unit dedicated to insurance-oriented patient journey and pre-authorization management represent the first of two phases of RCM.
• Pre-visit eligibility check is crucial as this enables hospital staff to collect patient information and verify a patient’s insurance coverage before an appointment. This step not only improves the patient experience during the actual visit, but it also avoids possible billing delays and reduces the volume of denied claims due to insurance ineligibility.
• Samco Global supports you in your health revenue cycle management journey by training hospital staff to accurately capture vital information, making sure that bills are prepared in a manner that correctly reflects the services provided.  We also analyse these data for medical invoicing, financial, and management reporting in line with ICD-10 and CPT codes.
• The second phase of RCM involves the conversion of collected information into a format that can be supplied to payers, using codes for reimbursement processing. This is currently done in the form of electronic claims (e-claims) and involves back-end tasks such as coding, claims submission, payment posting, statement processing and management of denied claims.
• Having a cohesive structure in place improves time management, communication, regulatory compliance, and the ability to spot possible coding and billing oversight, allowing providers to maximise revenue cycle opportunities at point of care.