Our Revenue Cycle Management Solutions

Request Demo

System and setup

End to end RCM Solutions

Business Intelligence Solutions

Key Medical Billing Metrics

Practice Management Programs

SYSTEM AND SETUP

PATIENT STATEMENT APPOINTMENT SCHEDULING DENIALS MANAGEMENT PATIENT REGISTRATION PAYMENT POSTING CODING INSURANCE ELIGIBILITY VERIFICATION WORKING ON CLEARING HOUSE REJECTIONS PATIENT CLAIMS TRANSMISSION CHARGE ENTRY LEGAL COLLECTIONS AR FOLLOW UP END-TO-END RCM SOLUTIONS

Medical coding

With our well‐versed coders, you’ll have one of the most experienced coding teams on your side. Our coding team provides you with a customized solution for your needs, which helps meet your specific scope, requirements, preference and budget. In addition, you get access to our technology and best practices.

SCHEDULING, ELIGIBILITY VERIFICATION AND PRE-AUTHORIZATION

An efficient revenue cycle management begins with the implementation of best process practices from day one. Most insurances require pre‐authorizations for you to get paid for your services. Having access to the most up‐to‐date eligibility and benefits data, De Lune Health helps increase clean claims rates, eliminates costly rework, accelerates reimbursement that increases time‐of‐service collections, minimizes bad debt, and boosts patient satisfaction. These processes take the guesswork out of whether services are covered or being denied because the “Procedure requires referral or authorization.” Many denials can be eliminated by proper coverage verification, and by obtaining referral/authorization prior to providing the services.

CHARGE POSTING OR CHARGE VERIFICATIONS

Medical claims are generated by experienced billing associates, based on state carrier policies and billing guidelines. Once the charges are created, they are keyed in with appropriate procedure, diagnosis and specific payment modifiers (if applicable). Multiple quality checks are performed before the charges are transmitted to carriers (e.g. verifying patient name, ensuring appropriate pointers were picked for ICD‐10 codes based on LCD and NCD guidelines with concurrent CPT codes, and appropriate insurance being billed). EDI clearance is performed by our senior associates, who are diligent in identifying, fixing and eradicating the cause in future claims. Our main focus is to submit a 100% clean claim and ensure proper submission.

ACCOUNTS RECEIVABLE MANAGEMENT

For healthcare providers and hospitals, the process of filing and following up on insurance claims is critical, especially in light of the trends of falling rates of reimbursement, increasing patient deductibles and rising operating costs. Accounts Receivable (AR) management is a dedicated process wherein unwanted account aging, escalating number of AR days and denials can be checked. De Lune Health is among the leading healthcare BPO companies, and we provide reliable and systematic Accounts Receivable Management outsourcing services which includes claims examination, prioritization based on the age of the claim, and periodic follow‐ups over phone (with email and/or online follow‐ups to update the status of each claim submitted to the insurance company), helping healthcare providers to shorten their revenue cycle and improve cash flow.

DENIAL MANAGEMENT AND DENIAL TRENDING ANALYSIS

Rebilling is an expensive endeavor and, we believe that denials should be prevented, even before they occur. De Lune Health denials analytics management’s primary goal is to help providers achieve nearly 100% of first‐pass claim payment, and eliminate denials. De Lune Health denials analytics solution analyzes your electronic remittances and categorizes denied charges into relevant groups, creating actionable work queues. Combined with our expert analysis, we identify the root cause of denials, set up a process improvement to prevent future denials, and track results.

PAYMENT POSTING

While many administrators look at coding and clinical documentation as the key anchors for effective medical billing and consider payment posting to be just the process of posting payments, a good payment processing team can provide critical insights into the overall effectiveness of your revenue cycle processes. Remittance processing professionals not only process payments but provide you trends and understanding on reasons for denials, pre‐authorization, non‐covered services, quality of your clinical documentation and coding processes, and effectiveness of your front‐end patient collections. We process the following types of remittance transactions with an exceptional degree of accuracy and timeliness.

  • Electronic Remittance Advisory (ERA) Posting
  • Manual Payment Posting
  • Denial Posting
  • Patient Payment Posting

CREDIT BALANCE RESOLUTIONS

Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial risks. Researching and correcting posting errors, duplicate payments, overpayments, and misapplied credits are not only time consuming, but expensive. However, failure to address these credit balances in a timely manner may result in missed billing opportunities, and when associated with government payers, may also bring compliance risks and penalties. Following are 10 best practices followed by De Lune Health to help you with your credit balance resolutions:

  • Identify true overpayments
  • Work balances oldest to newest
  • Analyze credit balances
  • Identify whether the patient is an eligible Medicare beneficiary
  • Adhere to applicable Medicare payment rules
  • Identify primary payer and other liable insurers
  • Verify validity that all credit balances are due and refundable
  • Monitor staff compliance with policies/procedures
  • Identify preventable causes of credit balances

PATIENT BILLS

We transmit patient statements on a monthly basis, after reviewing each balance before transmitting the statements.

  • We have a dedicated account management team that works from 8:30am to 5:30pm EST, Monday through Friday to serve you
  • We provide account management support, meetings and onsite visits

Key Medical Billing Metrics

De Lune Health understands how important it is to keep a close watch on some of the key medical billing metrics which will help optimize your revenue cycle. Monitoring your practice’s performance while providing exceptional patient care is vital to your medical group’s success. As a healthcare provider, there are several medical billing metrics that determine your practice’s billing effectiveness and efficiency. We always strive to take a proactive approach with the following medical billing metrics which will help keep your business profitable, giving you more time to focus on patient care.

Our goal is to maintain the percentage of A/R standards aligning with the Medical Group Management Association (MGMA) standards
Accounts Receivable Benchmark Practice MGMA
% of AR 0 - 30 Days 73 % 57 %
% of AR 31 - 60 Days 73 % 57 %
% of AR 61 - 90 Days 73 % 57 %
% of AR 91 - 120 Days 73 % 57 %
% of AR over 120 Days 73 % 57 %
Credit Balance % of AR 2 % <5 %
Days in AR 53 38
Credit Balance % of AR 43 % 54 %

Practice Management Programs

De Lune Health’s experience with multiple healthcare systems is a key factor in efficiency and accuracy. Our billing specialists have a vast experience in these practice management systems. These Electronic Health Records (EHR) software’s with prioritized task donuts, patient cards & physician dashboard to unify all roles of your practice to improve clinical care while creating a more personal experience with patients.