Revenue Cycle Management (RCM)
The Raw Group specializes in executing the entire billing process for healthcare providers, from start to finish.
Learn more below about our RCM basic and premium product offerings that can help your facility streamline its billing process.
RAW RCM Offering: RCM Basic Vs. RCM Premium
Eligibility Verifications, Prior-Authorizations & Referrals
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| VERIFY PATIENT ELIGIBILITY AND BENEFITS PRIOR TO A VISIT OR A PROCEDURE |  |
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| OBTAIN PRIOR AUTHORIZATIONS (IF NEEDED) FOR A PROCEDURE AND ENTER INTO PM SYSTEM | |
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| OBTAIN REFERRAL (IF NEEDED) AND ENTER INTO PM SYSTEM | |
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Billing
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| PATIENT CHECK-IN AND COPAY COLLECTION | |
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| CAPTURE CHARGES FROM PATIENT ENCOUNTER DATA RETRIEVED THRU CARE360 EHR | |
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| WEBCODER | |
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| SCRUB ENCOUNTER DATA, CONFORMING TO USE OF APPROPRIATE MODIFIERS, POS, TOS, ETC. | |
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| MISSING/INVALID ENCOUNTER DATA WILL BE COMMUNICATED TO THE PROVIDER | |
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| CLAIM REJECTION MANAGEMENT WITH PROVIDER SUPPORT | |
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| CLAIM GENERATION AND SUBMISSION TO THE CLEARINGHOUSE | |
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| CLAIM ACKNOWLEDGEMENT REPORTS FROM THE CLEARINGHOUSE | |
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| CLAIM REJECTION DUE TO INCONSISTENCY IN PATIENT / INSURANCE DATA WILL BE COMMUNICATED TO THE PROVIDER AND RCM PARTNER, AND THE PROVIDER WILL CORRECT THE CLAIM FOR RESUBMISSION | |
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Payment Posting
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| POST ERAS/PAPER EOBS | |
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| REVIEW PAYMENTS WITH APPROPRIATE ADJUSTMENTS BY CONFORMING TO CONTRACTUAL ALLOWABLES OF VARIOUS PAYERS | |
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| FIND DISCREPANCIES ON ERAS/EOBS WITH RESPECT TO INCORRECT CLAIM PROCESSING THAT RESULTED IN UNDER-PAYMENT OR PARTIAL DENIAL; INITIATE FOLLOW-UP/APPEAL PROCESS TO COMPEL THE PAYER TO ISSUE CORRECT PAYMENT | |
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| DENIAL MANAGEMENT | |
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A/R Management
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| GENERATE 30 DAY A/R REPORTS AND FOLLOW UP WITH PAYERS FOR OUTSTANDING CLAIMS | |
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| IF CLAIM IS DENIED DURING A/R FOLLOW UP, DENIAL MANAGEMENT PROCESS WILL BE INITIATED AND APPEAL WILL BE SENT WITH SUPPORTING DOCUMENTS (WITH PROVIDER SUPPORT) TO OVERTURN THE DENIAL | |
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Patient Billing
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| PATIENT RESPONSIBILITY INCLUDING DEDUCTIBLE, CO-INSURANCE, AND NON-COVERED SERVICES WILL BE BILLED TO THE PATIENT BY MAILING AT LEAST TWO MONTHLY STATEMENTS AND ONE PRE-COLLECTIONS STATEMENT | |
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| WEBPAYER | |
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| PROVIDE PHONE SUPPORT FOR PATIENT QUERIES | |
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| ACCEPT AND PROCESS PATIENT PAYMENTS | |
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| COLLECTION AGENCY SUPPORT FOR PATIENT NON-PAYMENTS (OPTIONAL) | |
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Financial Reports and Analysis
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
|---|---|---|---|
| GENERATE STANDARD MONTHLY BILLING AND COLLECTIONS REPORTS | |
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| CUSTOMIZE CGM WEBPRACTICE COMPATIBLE REPORTS INCLUDING GRAPHICAL ANALYSIS | |
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Account Manager
| SERVICE PROVIDED | PROVIDER | RCM BASE | RCM PREMIUM |
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| ACCOUNT MANAGER WITH E-MAIL SUPPORT | |
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| DEDICATED ACCOUNT MANAGER WITH E-MAIL AND PHONE SUPPORT | |
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