Pre-Billing

A strong revenue cycle begins with an efficient patient access process that ensures timely scheduling, eligibility verification, and charge capture. Our solutions reduce administrative errors, streamline front-end operations, and enhance the patient experience.

Services include :

By optimizing these front-end processes, we help healthcare organizations increase first-pass acceptance rates, reduce claim rejections, and enhance patient satisfaction.

• Charge Capture – Ensuring accurate documentation for optimal reimbursement.
• Missed Visits Management – Reducing scheduling gaps & improving patient retention.
• Charge Validation & Verification – Minimizing billing errors and revenue loss.
• Eligibility & Benefit Verification – Real-time insurance validation for fewer claim denials.
• Prior Authorization Management – Faster approvals, reduced wait times.

Billing and Payments

At Optimize RCM we ensure accurate, efficient, and compliant billing processes that help healthcare organizations accelerate reimbursements and reduce revenue loss.

Services include :

• Patient Data Entry – Securing and maintaining accurate patient demographics, insurance details, and contact information for smooth claim processing.
• Patient Data Entry – Securing and maintaining accurate patient demographics, insurance details, and contact information for smooth claim processing.
• Charge Capture & Submission – Ensuring error-free documentation of procedures and services rendered to prevent billing discrepancies.
• Payment Posting & Reconciliation – Efficiently recording and applying payments, reducing outstanding balances, and ensuring financial transparency.
• Claims Scrubbing & Submission – Identifying potential errors before claim submission, improving acceptance rates, and reducing delays.
• Billing Compliance & Audits – Ensuring adherence to payer policies, government regulations, and industry best practices to mitigate compliance risks.

Accounts Receivable

At Optimize RCM, we maintain a healthy cash flow and reduce outstanding balances. Optimize RCM helps healthcare organizations accelerate collections, optimize revenue cycles, and reduce bad debts.

Services include :

• AR Monitoring & Follow-Up – Regularly tracking outstanding claims and payments to prevent aging receivables.
• Segmentation of Collectibles & Non-Collectibles – Prioritizing high-value claims and optimizing recovery strategies.
• Aged Trial Balance (ATB) Analysis – Identifying trends in aged receivables, preventing revenue loss, and refining financial planning.
• Denial Recovery & Resubmissions – Analyzing denied claims, submitting appeals, and ensuring maximum reimbursement.
• Insurance & Patient Collections – Engaging payers and patients for timely payments while maintaining compliance with fair billing practices.

Denial Management

Our comprehensive denial management services help healthcare providers recover lost revenue, reduce claim rejections, and enhance financial performance through a proactive, data-driven approach.

Services include :

• Automated Claim Generation & Submission – Enhancing accuracy and efficiency in claims processing.
• Denial Analysis & Root Cause Identification – Investigating trends and patterns to prevent recurring claim rejections.
• Appeals & Follow-Ups – Proactively handling denied claims, facilitating direct payer communication, and ensuring maximum recoveries.
• Provider Credential Updates – Maintaining up-to-date provider credentials to avoid claim denials due to outdated information.
• Real-Time Reporting & Analytics – Providing actionable insights to optimize denial prevention strategies.

Credentialing

Provider credentialing is a critical process that ensures compliance and enables seamless payer enrollments. We streamline this process to reduce administrative burdens and accelerate approvals.

Services include :

• Provider/Payer Enrollment – Assisting healthcare professionals with credentialing applications and approvals.
• Re-Credentialing & Renewals – Managing timely updates and renewals to prevent coverage disruptions.
• Insurance Contracting & Negotiation – Securing optimal payer contracts to enhance reimbursement rates.
• Document & License Verification – Thoroughly reviewing provider credentials to maintain compliance with regulations.
• Ongoing Compliance Management – Keeping healthcare organizations compliant with state, federal, and payer-specific requirements.

Medical Coding

At Optimize RCM, we ensure compliance, maximized reimbursements, and reduced audit risks. Our team of certified coders follows the latest industry guidelines, ensuring precise and error-free documentation.

Services include :

• Paper & Electronic Charts – Ensuring coding accuracy for both digital and paper-based medical records.
• Inpatient & Outpatient Coding – Providing specialized coding support for hospitals, clinics, and ambulatory care settings.
• Electronic-Assisted Coding – Leveraging AI and automation for efficient, error-free coding.
• Deficiency Reporting – Identifying gaps in provider documentation, ensuring complete and accurate patient records.
• Physician Training & Education – Conducting regular training on coding best practices to prevent compliance risks.