
Revenue Cycle Management (RCM) is crucial for businesses, particularly in the healthcare sector, as it directly impacts financial performance and operational efficiency. A well-structured RCM process ensures timely billing, accurate claim submissions, and effective follow-up on payments, which collectively enhance cash flow and minimize revenue leakage. By improving the management of patient accounts, tracking services rendered, and optimizing reimbursement processes, organizations can reduce administrative burdens, leading to better resource allocation and heightened focus on patient care. Ultimately, an effective RCM strategy not only boosts profitability but also strengthens the overall sustainability of the business in a competitive landscape..
ProVia RCM Partners Excellence in Every Claim. Integrity in Every Step.
ProVia RCM Partners Excellence in Every Claim. Integrity in Every Step.
Services Provided
Patient Registration & Eligibility Verification
Collect and validate patient demographic information
Verify insurance eligibility and benefits
Confirm authorization/referral requirements
Claim Submission
Prepare and scrub claims to prevent denials
Submit clean claims to insurance payers electronically or via paper (as required)
Patient Billing & Collections
Send accurate statements to patients
Set up payment plans and follow up on outstanding balances
Handle inbound patient billing inquiries
Charge Capture
Ensure coding aligns with documentation and payer guidelines
Accurately translate clinical services into billable charges
Payment Posting
Post payments from insurance and patients
Apply contractual adjustments, co-pays, deductibles, and patient responsibility
Reporting & Analytics
Provide detailed financial performance reports
Monitor KPIs such as days in A/R, denial rates, collection rates
Offer insights to improve practice revenue and workflow efficiency
Medical Coding
Assign appropriate CPT, ICD-10, and HCPCS codes
Ensure coding compliance with federal regulations and payer-specific rules
Denial Management & Appeals
Identify, analyze, and correct denied or rejected claims
Resubmit claims or initiate appeals when necessary
Compliance & Data Security
Ensure HIPAA compliance and protect patient information
Follow billing and coding regulations set by CMS and commercial payers
Revenue Optimization & Consulting
Identify inefficiencies or revenue leaks
Provide consulting services to improve reimbursement and reduce denials
Support payer contract negotiations if needed