Revenue Cycle Management in Clinical Workflows
Attempting to manage claim denials after the event is costly and causes unnecessary delays in revenue realization or results in revenue loss. Depending purely on the Medical Coding / Insurance teams, post the consult, is not the most effective way to ensure that denials don't occur. A good System starts very early to ensure a 'Zero Denial' environment and begins action much before the consultation with the Doctor starts.
Lifetrenz RCM solution can help you achieve near 'Zero Insurance Denials' with denials being averted early, much before the case reaches your insurance/ medical coding teams for claim submission.
Please read our white paper 'Avert Denials Early! Get it right on first submission', for more information on Activities that help avert claim denials.
RCM optimization during Consultation Activities
Lifetrenz System can empower the doctor in multiple ways to ensure claim denials are averted early during the consultation itself. Some of the key features in the Lifetrenz System, that help this process are given below:
System Highlights Services to Doctors Automatically, if it's Not Covered by Patient's Insurance
While the doctor is ordering any service, Lifetrenz System highlights the 'out of coverage' services to the doctor, which enables the doctor to avoid them and only order services that are covered by the patient's insurance policy. However, the doctor can choose to order an 'out of coverage' service if the patient is willing to pay out of his/her pocket for the service.
System Automatically Highlights Services which Need Authorization Mandatorily to Doctors
While the doctor is ordering services during the consult, Lifetrenz System highlights services that need 'Mandatory Prior Authorization', which enables the doctor to know if the case needs to go for authorisation before rendering the service.
System Alerts the Doctor of Parameters to Capture to meet eJADA/ other Regulatory Compliance
When the doctor completes a consult and marks the case as 'Ready to Bill', Lifetrenz System alerts the doctor if any of the 17 eJADA compliance requirements has not been fulfilled. Be it:
- > Vitals like BMI or BP which are not captured that may be mandatory for claim.
- > When assessment scores like FCA is not captured when required.
- > Or if any lab test is not ordered for a certain diagnosis when mandatory.
As the System alerts and doesn't allow the doctor to mark the consult as 'Ready to Bill' 'Ready to Bill' until all the mandatory data is captured, it ensures that 50% of the eJADA challenge is managed automatically. Rest of the eJADA challenge is managed by the System — by ensuring that the lab results mandatorily required are part of the claim.
System Validates if the Principal Diagnosis is Captured
Lifetrenz System can be configured to ensure that the doctors can place orders only after the 'Principal Diagnosis' is captured. Further, healthcare facilities can also mandate that any other data such as 'Patient Complaints' or 'History of Presenting Illness - HPI' is mandatorily captured by the doctor. It's a good practice to ensure that the Patient Complaints and HPI is included in the authorization and claim xml as observation, which helps in improving the claim success rate.
Lifetrenz System does not force the doctors to remember the ICD codes for the diagnosis. It allows doctors to search the diagnosis as text and the System automatically return results by not only searching from the master list of ICD codes but also based on alias names, short and long descriptions etc.
Medical Necessity Check for Orders
Lifetrenz System can validate if all the 'orders / services / activities' in the consult for a diagnosis captured will pass the claim process or if it is likely to fail the 'Medical Necessity' check. For this Lifetrenz integrates to a third party product and does the check in real time during the consult process. Further, the System can also suggest 'alternate/more specific' diagnosis that will allow the 'order / service / activity' to pass through authorization and claim. This enables the doctor to change the order or correct the appropriate diagnosis for the case, well in advance and ensures lower rejections.
Capture of 'Consult Evaluation Type' for Certain Specialities
For certain specialities the consultation charge can vary based on the 'Type of Evaluation' conducted during the consultation. These are widely used for the specializations of 'Dentistry' and 'Psychiatry'. Lifetrenz System allows such configuration for any speciality and automates the billing process.
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For a description of some of the important processes covered in our RCM, please click on the links below
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Revenue Cycle Management
The most powerful and automated Contract Management and Revenue Cycle management system in the region, can help you achieve Zero Denials, increased revenues and faster revenue realization...
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RCM in Clinic Workflows
Attempting to manage claim denials after the event, is costly and causes unnecessary delays in revenue realization. Depending purely on the Medical coding team post the consult is not the most effective way...
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Insurance Contract Management
With 95% of your patients being covered by Insurance it is imperative that you have a very elaborate Contract management system that can capture and configure all the variable rules around...
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Claim Processing
Lifetrenz RCM module is a New generation solution, the RCM maintains Separate Workflow Queues and maintains the Stages of a case within each Queue. The Queues maintained are for ePrescription,...
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AR & RA Reconcilliation
The Lifetrenz RCM solution has an elaborate Accounts Receivable module to Manage all account receivables and reconcile Remittance Advice from insurance payments.
When the bills are Finalized in OP DNFB... -
eJADA Compliance
With over 17 eJADA parameters to mandatorily submit in your eClaim XML, the Lifetrenz Clinic Management ensures that the doctor Captures all mandatory parameters and the Lab results mandated...
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eSource Reports
Dubai Statistics Center (DSC) has mandated 19 reports in two parts (emirati and non emirati) to be submitted monthly or annually. Lifetrenz Clinic allows you generate these report in the prescribed template format from the system with a single click...
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Request a Demo
If you are a decision maker at a Healthcare Facility, and would like to see a Demonstration of any of our Products for the Healthcare Vertical, We would be keen to demonstrate the same. See all the workflow and processes at you clinic in a demo.