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Our Services

Our Revenue Cycle Management Solutions can be tailored to meet the financial needs of your practice. Outsourcing your medical billing to Optimal RCMS is a win-win situation.

The team at Optimal RCMS is dedicated to building mutually beneficial partnerships through trust, education, complete transparency and ethical business dealings.

We understand that revenue leaks stem from various sources. Two of the leading contributors to a decline in revenues are incorrect claims submissions and a lack of attention to the aging process.

All healthcare providers must be paid for their services in a rapid manner and on a consistent basis to avoid unnecessary fluctuation in revenues. Our number one priority is to increase your revenues.

Optimal RCMS overcomes the challenges that may result in a loss of income due to underpricing, missing charges and uncollected claims utilizing revenue cycle management best practices, technology and perseverance. We fight for your money while you tend to your patients.

VERIFICATION OF BENEFITS

Verifying benefits in advance allows us to obtain information regarding a member’s insurance coverage. Knowing this information up front helps to alleviate surprises, allows for identification of insurance company inconsistencies and is used in cases where appeals may need to be written.

In most cases, our clients receive a detailed written report on eligibility, any relevant restrictions, prior authorizations (if required) and recommendations on the patient’s insurance coverage (as applicable) in 24 hours.

PROCESSING CLAIMS

Claims processing is the fulfillment, by an insurer, of its obligation to receive, investigate and act on a claim filed by an insured. It involves multiple administrative and customer service layers that include review, investigation, adjustment (if necessary), remittance or denial of the claim.

The Optimal RCMS team places heavy emphasis on processing of all your claims within 72 hours of receipt.

UTILIZATION REVIEW (UR)

Utilization Review is a health insurance company’s opportunity to review a request for medical treatment. The purpose of the review is to confirm that the plan provides coverage for your medical services. It also helps the company minimize costs and determine if the recommended treatment is appropriate.

Our in-house Clinical team (UR Specialists) will assist your team/facility by maximizing patient’s insurance benefits.

AGING REPORTS

All claims are audited weekly, and the status of each claim is communicated to our clients on a weekly basis in a detailed report. Once a month, we provide an insurance aging report to our clients and can include a patient aging report if we provide patient billing services for you.

RECOVERY SERVICE

We will address, audit and appeal all claims and denials (up to 12 months from the date of service) and negotiate payout amounts with payors.

We have found success for our clients through our internal appeals process that includes (but is not limited to), communications and negotiations with healthcare payors, local government officials, assembly and congressmen and women, attorneys, regulatory affairs analysts, advocacy groups, arbitrators and the Department of Insurance (DOI).

PATIENT INVOICING

This service includes generating patient invoices and/or direct phone calls on any outstanding co-pays, co-insurance or deductibles. Our staff communicates with your patients in a tactful, respectable and business-like manner.

PAYOR (PROVIDER) ENROLLMENT

Get your providers billable quickly. When you partner with Optimal RCMS for payor enrollment services, we take on the heavy-lifting of getting your providers enrolled. You have an entire team of experts working for you. We collect your data just once, then secure the appropriate applications and prep them for signature by your providers.

We work with all government, commercial and private payors. We create and maintain CAQH, NPPES/NPI and PECOS profiles. All provider/facility information is kept securely in a cloud-based portal which runs on the backbone of the Amazon Cloud Service. This allows for all demographic information and expirables to be updated quickly and applications prepared in a timely manner.