End to End Revenue Cycle Management
The CMI Group's end to end revenue cycle management solution relieves healthcare practitioners from the burden of administrative toil so that they can focus on helping patients and growing their practice. Whether you are looking for an end to end RCM solution or need support with one of the particular steps of revenue cycle management we've got you covered!
Integrated with your back office system we gather primary source material automatically for initial credentialing and re-credentialing submissions. Credentialing specialists augment our automated process when necessary to gather additional information and review final submission packages. After credentialing submission CMI will continuously monitor, follow up for status updates, and respond to additional requests until approval. Additionally, CMI will manage your providers' re-credentialing schedule on an ongoing basis.
Eligibility & Verification
Verifying patient insurance eligibility is the first and arguably most important step in the revenue cycle. Our team specializes in payer outreach to ensure active insurance and to verify specialty-specific coverage for your patients. We work with patients to obtain information on all active policies to correctly identify coordination of benefits for prompt and accurate filing of your claims. CMI expects a 95% clean claim rate and it all starts with eligibility verification.
When certain payers require authorization for a procedure, service, or medication, the time and effort needed from your staff increases significantly. Our agents specialize in payer outreach to obtain these authorizations, allowing your staff to prioritize other tasks in the office. We work with your staff and payers to coordinate medical records requests and continue following up periodically until authorization is finalized and documented in your system.
Thorough and precise coding is integral to clean claims and complete reimbursement for your facility. Our highly experienced and trained coders work within your medical record to review encounter notes and assign appropriate CPT, ICD-10, and HCPCs codes. Certified coding trainers work to keep ahead of coding changes and trends, ensuring timely continuing education to our team and keeping our coding standards ahead of the curve. Our credentialed coders work flexible hours to meet the needs of our clients, striving for complete and accurate coding that can stand up to audits and obtain optimal reimbursement for your office. Finding the right vendor-partner for coding can help your office to realize measurable results in your financials through improved cash flow, reduced Discharged Not Final Billed (DNFB)/ Discharged Not Final Charged (DNFC), and improved Case Mix Index and Diagnosis Related Group (DRG)-reimbursed revenue.
Clean claim submission rates vary across the country, but best practice is to have a clean claim rate of at least 90%. That means 90% of your claims going through your clearinghouse the first time without errors, preventable denials, or a complete rejection. Studies show that between 50% and 65% of denials remain unworked because staff does not have the time or knowledge to resolve them. Our team has a 95% average clean claim rate and with over 6 million claims processed per year. You can rely on CMI to help you increase your reimbursement.
Proper understanding and application of incoming payments is required for accurate accounting and financials. With over $1 billion dollars in payments posted over the last 10 years, our team is highly trained and experienced in interpreting multi-specialty insurance and patient payments. We work within your system to apply these payments to the correct accounts and invoices, the first time, every time. We have found that over 95% of practices experience a recovery of lost revenue, some of which could be from misallocated funds from payment posting.
A/R Follow Up
Is your AR increasing as time passes? Are you seeing a decrease in collections from insurance payers? CMI can help decrease your days in AR and increase recognized revenue from payers, while giving your staff back integral time to focus on more difficult claims and payer issues. Our team specializes in working within your EMR to complete follow up tasks and provide transparency and real-time updates in your system.
As patient balances age and become past due, facilities spend less and less time pursuing the balances before sending them to collections. At The CMI Group we specialize in 1st party collections, meaning pre-collections efforts that occur before an account is defaulted and send to a collection agency. Our soft-touch telephone campaigns work with your patients to resolve their balances prior to write off with agents that call as representatives of your facility. These pre-collection efforts increase revenue for your office, decrease collections cost, and help to maintain a position reputation in your community.
Are your concerned about cash flow, struggling to find qualified billing staff or seeing a decrease in collections? Contact us to schedule your free revenue cycle assessment. We’ll scan your back-office system to extract KPIs and build a report card based on best practices with actionable items