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

Comprehensive RCM Solutions

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Comprehensive RCM Solutions *

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