RCMS (Revenue Cycle Management System)

Patient Eligibility & Benefits verification services

Physicians need to validate each patient’s eligibility and benefits to make sure they will receive payment for services rendered. RTMS offers comprehensive Patient Eligibility & Benefits verification services to help healthcare providers confirm check coverage prior to the office visit. Our primary is focus is on preventing denials and avoiding delays in payment, which will
boost revenue at time of service, save time on the back end, and also enhance patient satisfaction. RTMS has an extensive experience in working with government insurance as well as commercial insurance companies such a United Healthcare, AETNA, and others. We provide customized patient eligibility verification services for all medical specialties and practices of all sizes.

Our goal is to

  • Eradicate the need for tedious in-house verification processes
  • Free up your staff for other tasks
  • Curtail bad debts
  • Increase cash collection
  • Reduce billing mistakes and denials
  • Improve patient satisfaction
  • Save on your operational costs

We verify patients’ insurance eligibility by checking the carrier website or calling up the company. As the success or failure of each patient claim starts at the Providers front desk, we confirm the following before the appointment.

RTMS Process Flow:

  • We receive our workflow through the patient scheduling system, EDI, e-Fax, emails, and FTP files.
  • We initially verify primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible / co-insurance information, and benefit information.
  • We use the best channel (call or web) to connect with the payer. We perform automated eligibility verification using our enhanced software.

PRIOR AUTHORIZATION

RTMS prior authorization team is expert at:

  • Determining prior authorization requirements
  • Preparing and submitting necessary information to the payer
  • Following up on submitted prior-authorization requests
  • Notifying the providers in case any authorization issues are identified

Value Propositions

  • Optimize cash flow
  • Minimize patient denials and avoid rejection of claims by payers due to inaccurate or incomplete information
  • Identify the patient’s responsibility upfront.
  • Improve patient satisfaction
  • Process automation