Eligibility Verification
Prior to service being rendered by the provider, we verify the patient’s current insurance eligibility, update the patient’s account with current insurance eligibility status, and red flag any issues.
Patient Enrollment
We can guide practices in enrolling both underinsured and uninsured patients to foundation and PAP support programs.
Benefits Verification
Prior to service being rendered by the provider, we verify patient benefits and deductible balances in the patient’s account.
Demographics Verification
We can enter new patient demographics into the EMR and PMS system with checkpoints that verify all data is complete and accurate.
Authorization
We initiate and aggressively follow-up on pre-authorizations with payers wherever required to ensure that clients can deliver their services to patients without fear of non-payment.
A/R Management
Our Accounts Receivable team compares expected and actual collections, understands the cause for discrepancies, and takes corrective measures to recover the difference. Merger RCM's systematic and regulated processes during each phase of the revenue cycle allow our AR team to keep Days in AR to below 25. An initial analysis of old outstanding receivables will be performed whenever a new client joins Merger RCM, and corrective action will be taken to recover as much revenue as possible from claims filed prior to the client joining Merger RCM. Unpaid claims are processed using a prioritization based method, with high value claims and claims approaching the insurance timely filing limits given top priority. Any underpayment in the contracted amount or reimbursement rate of the insurance company will also be flagged and corrective action undertaken
Charge Posting
We follow a rigorous process of scrubbing claims during the charge posting process oriented towards maximizing first-time payments from insurers and minimizing denials.
Reporting
We provide customized performance reports based on our client’s needs.
Payment Posting
Insurance payments are posted to patient accounts from the EOB. All payments received will be posted within 24 hrs. For payers who do not have Electronic Remittance (ERA), our team manually posts the insurance payments into the patient’s account matching the respective allowed amount for each charge. To ensure that all payments received are posted, we compare bank deposits with the total payment posted in the PMS. If the patient has co-insurance, the remaining unpaid charges will be filed to the secondary insurance as per the coordination of benefits. Any deductibles, copays, Out-of-Pocket, and other patient responsibility stated by the insurance will be billed to the patient when the statements are generated. Before generating statements, we ensure that the patient account balance is correct and they are not billed for balances for which they are not liable. Patients’ statements are generated on a monthly basis.
Credentialing
Insurance / Clearinghouse Credentialing We have staff specializing in healthcare insurance enrollment & credentialing. Our singular focus is to eliminate errors, foresee potential obstacles, and avoid delays getting you on the insurance panel of a participating provider while ensuring that you stay current. Merger RCM guarantees the confidentiality and security of provider information.