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Review how providers working with Medicaid and managed care organizations may obtain the highest percentage of billing in the shortest timeline, review how to ensure claims are as clean as possible, and discuss how to make claims follow-up consistent and timely.
Revenue cycle management needs to contain procedures to ensure that billing is timely and complies with payer contracts and process requirements. Some providers can struggle with direct Medicaid program reimbursement and/or during Managed Care transition and long afterward.
Thin margins in our industry magnify this impact. Denials prevent timely and complete payment, impacting cash flow and resource requirements in the Revenue Cycle department. The learning curve is often very difficult, especially when dealing with multiple payers with different systems and processes, and with claims and EVV aggregators.
Appropriate up-front management of the Revenue Cycle can serve to minimize aggregator and claims clearinghouse rejections and payer denials, thereby improving payments and required “re-touches” to get claims paid and minimizing write-offs.
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