Revenue Cycle Management
Helping your organization navigate the complete revenue cycle
Hospitals and health systems face more obstacles to payment than any other industry. Margins are tight and regulations keep changing. Meanwhile, the complexity of billing processes often leads to costly mistakes. At PrologiQ, we get it! We’ll partner with you to build expert solutions that keep your revenue cycle running smoothly.
Accounts Receivable – workflow technology
Our proprietary Accounts Receivable workflow tool aggregates AR data and stratifies the claims into different queues. Claims with the highest propensity of being paid are triggered to your team’s queues first – allowing us to maximize the amount of cash flow we can bring in for your business.
The system is intelligent allowing it to learn and adapt over time automatically promoting claims with the highest conversion rates. In addition to the adaptive learning, specific rules can be created to enhance workflow management. Basic assignment rules include time taken by insurance to pay, aged ANSI, and filing limits per payer for example. Rules can also be custom made to your specific business preferences. Essentially, any data element provided by the client can be used to specify an account assignment to one or more agent.
PrologiQ offers an end-to-end RCM solution or a part based on the customer’s business requirement thereby addressing the core concerns that healthcare companies face in maintaining financial stability and continuously improving the quality of patient care
Services Highlights :
- Medical coding – Due to constantly changing healthcare regulations and governmental standards, PrologiQ regularly trains individuals regarding the most recent requirements. This includes up-to-date versions of CPT and ICD coding guidelines.
- Charge capture – Dependent on the patient, you’ll need to service Medicare and Medicaid patients, third-party insurance patients, and worker’s comp claims. Charge captures of all types will need to be handled.
- Claims & Claim Denials – We will also handle the generation and submission of insurance claims. In addition, we can organize the explanation of benefits (EOB). Denied claims will need to be corrected and resubmitted for appeal, often within a strict time frame.
- Payment posting – PrologiQ offers fairly swift posting of payments into your billing system. After payment is complete, we can offer auditing and analysis of all payment information.
- Accounts receivable – One of the most dreaded situations for any healthcare organization is the halt in revenue that occurs with accounts receivable bottlenecks due to failed or under-payments. PrologiQ can tackle your accounts receivable, provide the necessary follow-ups, and reduce the amount of time between claims submission and reimbursement.
- Data reporting – PrologiQ will provide you with data points and key performance indicators, usually on a monthly basis. Access to these figures and analysis will help you determine the potential for growth as well as areas of improvement.
Dedicated team of industry experts to manage your revenue
Upon implementation, you are assigned a team of regulatory and payment experts to work your billing cycle from claims generation, to payment posting, to insurance collections. In addition to this talented team, you will also be assigned a dedicated Account Executive.
Your Account Executive serves as your key contact and trusted advisor. They are responsible for establishing and maintaining strong relationships and high levels of customer satisfaction. They will also conduct monthly financial reviews that examine performance against mutually agreed upon key performance indicators as well as identifying ways to improve performance on an ongoing basis. Perpetual improvement is mandatory in such a complex environment.
Powerful analytics demonstrate performance
PrologiQ knows transparency is critical for our customers. Using powerful, proprietary dashboards, your PrologiQ Account Executive will conduct regular performance reviews helping you understand and analyze your results against key performance indicators. With the ability to drill down to every detail of your revenue cycle, you’ll be able to see every aspect of your revenue cycle. The system is intelligent allowing it to learn and adapt over time automatically promoting claims with the highest conversion rates.
In addition to the adaptive learning, specific rules can be created to enhance workflow management. Basic assignment rules include time taken by insurance to pay, aged ANSI, and filing limits per payer for example. Rules can also be custom made to your specific business preferences. Essentially, any data element provided by the client can be used to specify an account assignment to one or more agent.