RCM & Billing Services

Below is a staged representation of our Revenue Cycle Management and Billing services.

Eligibility Verification:

Over 50% of all health care claims are denied because a patient is not eligible for services billed to the insurer. Often, a patient would be ineligible to claim for benefits because the policy has been terminated or modified. Unfortunately Eligibility Verification is one of the most neglected elements in the revenue cycle. Promantra can help practices significantly increase their revenue by reducing the ineligibility.

Numerous problems are created due to lack of proper eligibility and benefit verification. These include delayed payments, increased errors, non-payment of claims and patient dissatisfaction. To avoid these problems, Promantra provides a remotely hosted solution for Hospitals and Medical Practices. The solution consists of Promantra deploying expert staff that can be accessed via a toll free number working remotely, with an objective of delivering high quality cost effective patient insurance eligibility and related services.

Charge Entry:

Charge entry is carried by gathering all charge documents from all departments, within the facility that have provided services to patients. Promantra Charge Entry team gathers all the information required for charge capture from the client file, patient demographic file and the charge ticket/sheet.

Payment Posting:

When payments are received, the appropriate payments and insurance carriers are posted to the patient accounts along with any patient payments until the balance has been satisfied. Promantra carefully checks EOB / Private Checks or scanned credit card statements are used to capture details like Patient Account Number / Patient Control Number, Patient Name, Date of Service, Procedure Code, Billed Amount, Allowed Amount, Adjusted Amount, Paid Amount, Deductibles and Denial Details, Refunds, Offsets and Reconciliation.

Billing:

After final payment has been made by the insurance carries, the accounts are assigned to representatives, to invoice patients, and notify the patients with follow up reminders, of their responsibility to pay and arrangements made for payment.

AR Follow-up:

With highly skilled associates and cutting edge technology, Promantra can enhance Provider’s revenue and sequentially increase your organization’s bottom line by managing charge entry, payment processing, reducing days in A/R, claims submission improving collection ratio and increase the probability of payment through timely follow-up. We have Certified Billers who are heading our team with a minimum of 8 years experience and a team’s average experience of 5 years. Based on our findings, we have aligned our resources and our delivery model to maximize revenues for practices

• 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers.
• 50% of denied claims are never re-filed.
• 50-70% of denied claims have higher chance of being recovered.

Denial Management:

Our denial management process reports and measures all claims that are being denied by your payers. With this level of data our Denial Management specialists can fix the issues that are leading to the denials (whether it be issues with the claims or issues with the payers) and stop the torrent of unpaid claims into your medical billing process. Once we do this, then revenues for your practice will increase; probably by 20 percent.

At Promantra, our Denial management Process tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. With this powerful combination in hand, the Practice / Provider of medical service can then utilize claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims.