Medical Billing | Revenue Cycle Management (RCM)

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You do the Practice, We do the Payments

PrognoCIS Revenue Cycle Management (RCM) and Medical Billing services combine EHR workflow and payment collections into a simple, single source. While you provide the medical services, we will take care of:

  • Dedicated RCM client services manager
  • Eligibility checking
  • Processing of patient statements
  • Build customized scrubber checks to meet state, specialty and practice specific billing guidelines
  • Claim follow-up to ensure payer acceptance
  • Designated call center to take patient calls
  • Posted updates on insurance payments, patient payments, and denials
  • Denials management, appeals management
  • All claims touched at day 30, if not paid

By using PrognoCIS RCM, your practice benefits from combining thousands of man-hours in payment experiences, as well as optimizing returns with proprietary scrubbing algorithms to shorten cycles. And, because the billing data and codes from the assessment are automatically forwarded to claims for billing there is no need to create or pass superbills from the practitioner to the billers.

This allows you to focus on connecting with your patients and providing services without having to worry about the nuances of payment collections. In the event there is a billing issue to sort out, the integrated software provides easy communication and assignment of tasks between clinic and RCM team. And, with PrognoCIS, our ICD-10 submissions are as good or better than with ICD-9, so you can continue practicing with predictable prosperity. Learn more about the payment solutions PrognoCIS offers.

Request RCM Services

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As part of our transparent claim management process, we offer daily/monthly/YTD financial statements and RCM reports. These reports are vital to fine tuning the efforts of a medical practice, and are provided at no extra charge, so you always know where your claims stand. Reports include:

  • Denials management report
  • AR analysis report
  • Month end report
  • Industry standards report
    • First pass rate – 92% or higher
    • Percent AR over 90 days – less than 15%
    • Days in AR – our goal is under 45 days

Patient Accounting Services

PrognoCIS RCM includes account resolution to manage your billing. Our Patient Account Services team will take calls from your patients as well as contact patients to settle statements.

When you sign up for PrognoCIS RCM, we also offer you a comprehensive package of our Premier features, including:

To learn more about getting PrognoCIS Premier for your practice, contact us.

Revenue growing

99% Error Free Claims

When 99% of the claims you submit to TriZetto’s clearinghouse in a quarter are approved, you can qualify for TriZetto’s 99% Club.

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