Revenue Cycle Management

Maximizing collections and reducing costs is essential to success in a Healthcare environment with declining reimbursements, increased denials, and growing complexity. MSM can help you achieve your goals by putting our unique combination of experience, skills, and technology to work for you.

MSM’s unique perspective on Revenue Cycle Management starts with a strategic partnership supported by a high level of service, transparent processes, and a strong desire to make your businesses succeed. We nourish this partnership with a balance of cutting edge technology, efficient processes, and an expert staff.

At MSM, we benchmark all of our productivity against national and specialty specific industry standards and set goals that exceed those standards. We demonstrate transparency in each step of the Revenue Cycle process by providing your practice with daily, monthly, and real-time reporting. Most importantly, we never sacrifice the quality of our services by outsourcing.

Data Capture

Effective charge capture is critical to optimize revenue. Our staff of integration experts will work with your team to develop a custom charge capture process that fits your practice while maintaining quality and efficiency. Our systems enable us to pull off the most complex integrations with ease. To validate the accuracy of our integrations, we perform monthly quality control analysis to ensure all charges are captured. Our goal is timely and accurate claim submission of all services that you perform.

Coding

MSM is committed to optimizing your revenue while maintaining compliance with all state and federal regulations. Appropriate documentation and coding is a key component to accomplish this goal. We employ a team of highly skilled, specialized certified coders (CPC, CSC, RCC) along with the latest in natural language processing technology to ensure that all billed services are well documented. We tailor a coding solution to fit the needs of your practice. To further our success, we match coders to clients based on their experience. This allows them to become familiar your practice, identify trends, and recommend changes to improve the revenue cycle process.

Claim Scrubbing

MSM’s sophisticated claim scrubbing processes enable us to improve cash flow and reduce denials by pinpointing problems before claims submission. Our systems allow us to build a custom set of rules for your practice as well as perform thousands of standard checks such as demographic validation, CPT/ICD-9 code compatibility, modifier usage, and payor policies. The rule set is continually improved and customized as payor policies and stall tactics change.

When our claim scrubber technology is employed we have seen significant improvements in both the speed and the magnitude of collections. Often, the submission of clean claims can result in over 90% being paid on the first submission.

Electronic Claim Submission

MSM can connect electronically with over 1,200 commercial and government payors through a national clearinghouse. The claims are run through a series of edits to ensure all critical elements are included before submitting them to the payor. When compared to paper, submitting electronically can resolve claims quicker and more accurately. Medicare secondary claims are also submitted electronically after the primary insurance adjudicates the claim. If, for some reason, the payor does not accept claims electronically, a paper claim is generated and mailed.

Payment Posting

MSM will establish a process for receipt of incoming payments and payor correspondence through a bank lockbox, local dedicated PO Box, or physical address. Insurance payments are received via ERA (electronic remittance advice) or on paper. Experienced payment posters will review, line-item post, and balance all payments received. Remaining balances after insurance payments are posted will be transferred to the next responsible party (secondary insurance, patient) for billing the next day.

Denial and Appeals Management

While our goal is to get paid the first time a claim is submitted, this is not always a reality. Health plans continue to change payment guidelines, fail to respond to claims submitted, and find ways to prevent paying for services rendered. A successful revenue cycle process addresses these issues by identifying and responding to trends in order to improve the claims submission process. Our intent is not only to resolve the denied claims, but prevent similar denials in the future.

Timely response to a payor denial is critical, therefore, we have developed a workflow tool that allows us to prioritize and automate follow-up actions. As a result, many claims are billed, denied, appealed and paid within 35 days.

We conduct a continuous review of your accounts receivables, denial trends, and operational improvement opportunities. This information is reviewed with you on a monthly basis.

Customer Service

Patient care should not end when the patient leaves your office. Our highly skilled customer service representatives are available Monday-Friday by phone, fax, and email to assist your patients with their billing related questions. A dedicated toll-free, local phone number is established allowing calls to be answered utilizing a custom greeting specific to your practice. We pride ourselves on ensuring the continuity of care and patient satisfaction throughout the billing process.

Whether covered by insurance or not, many patients will have some out of pocket expense when they receive medical care. MSM handles all patient billing functions including daily statements, past-due balance letters, payment plans, hardship requests, and collection agency accounts.

AR Management

Many revenue cycle management companies will describe A/R management as a reporting module- we feel there is much more to A/R management. In addition to a custom reporting package that illustrates the financial health of your practice, we personally review your metrics monthly. A designated member of our team acts as your internal advocate and assists in identifying areas for further improvement. We spend time with you or your designee, to ensure thorough understanding regarding the health of your practice. MSM is committed to continually refining our processes to ensure we continue to provide you with the highest quality service.


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Compliance audits
Periodic compliance audits are performed based on regulatory changes, coding updates and audit agency trends.
Contract performance
MSM can benchmark and evaluate the performance of your payor contracts to ensure health plans are meeting contractual obligations.
Custom patient web payment portal
MSM will establish a customized online payment portal that will allow your patients to review their statements and make payments online.
Dedicated client managers
Your client manager will assist you through implementation and with ongoing process improvement to ensure MSM is not only meeting but exceeding your expectations.
Education and training
MSM is available to assist with training your staff by providing comprehensive training programs related to billing concepts such as ABN’s, authorizations and interpreting insurance coverage.
Process improvement
A periodic operational audit of your practice is helpful in identifying opportunities for increased efficiency. MSM can assist you by performing a general operational audit to identify areas of opportunity and suggest possible solutions.
Records management
MSM maintains a paperless archiving system which allows for easy storage and retrieval of all billing documents. We can assist in responding to legal requests for records.


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