The document discusses how BillingParadise provides an interconnected platform to help coordinate revenue cycle management processes for multispecialty hospitals and medical groups. The platform allows for internal communication between departments, work allocation, ticketing for issue tracking, training updates, leave requests, and automation of processes like eligibility verification, prior authorization, coding reviews, EOB to ERA conversion, and patient statements. Coordinating these RCM functions through a single interconnected platform helps streamline operations and reduce costs.

1. www.billingparadise.com

2. INTRODUCTION :
Hospitals and medical groups with multiple specialties always struggle to coordinate
between various departments as specialist physicians need to coordinate with
screening labs, radiologists, and other specialists to create a progressive treatment plan for
the patient. Sometimes this process is interrupted and the patient’s progressive care is put
to a halt receiving a bad reputation amongst the patient population.
Interconnected RCM processes in multispeciality hospitals are essential to achieving
financial and patient care goals. We have listed down a few areas where your
multispeciality can perform well if organized properly.
INTERNAL COMMUNICATIONS :
The same platform designed to monitor resources is also used to perform day-to-day
internal communication between the respective departments and RCM teams. A few of the
notable features of internal communications are:
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3. FRONT OFFICE TO RCM TEAMS :
It is a well-known fact that the front office in every healthcare organization is the first point
of contact when it comes to registering patients. Coordination between the front office and
the patient eligibility and benefits verification department must be interconnected so that
the doctor treating the patient can engage in more benefits-related conversations with the
patient. This internal communication feature will allow front office staff to assign the
patients whose appointments are fixed in the upcoming days to the eligibility and benefits
verification department and then the verified data will be communicated and forwarded
within this platform itself.
WORK ALLOCATION :
Using this platform allows each and every department to assign work according
to the revenue cycle process. For example: After patients, eligibility and benefits
are checked we can forward the verified patient data to the Demo and charges
team to capture the information and transmit the claim to the insurance
companies. This shortens the time of email. Communication, because as soon
as the work allocation is done the respective department head will be notified
within seconds including the message from the eligibility department.
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4. TICKETING SYSTEM :
Ticketing or raising queries is an important part of this platform. Whether it is from the hospital or
clinic side or with the RCM team’s side, Raising tickets in regards to completing tasks or rectifying
certain process issues all are done using this Ticketing option. This ticket is visible through the
management hierarchy and the RCM directors and managers can track whether the queries are
solved or not as the open-closed or in-process categories are listed in the tickets allowing a smooth
process among the respective departments/teams.
UPDATES AND TRAINING :
Training is a vital part of every RCM process. Setting up daily targets
and updates can be easily conveyed through the internal
communications option.
Process trainers can pay close attention to the work done by the
RCM team and can provide necessary feedback to the staff who
need to improve and internal quizzes, and Q&A sessions can be
conducted using this platform’s internal communications feature.
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5. LEAVE REQUESTS AND TRANSFER OF WORK :
Staff who are looking to apply for leaves can directly communicate using the option leave application. This request will be
directly sent to the reporting authority of the particular RCM team or the hospital/clinic management. During the absence of
any staff transfer of work to other RCM staff can be applied using the internal communications features. This allows a non-
stop workflow even when an RCM or clinic/hospital staff is on leave.
PRE CLAIM AND POST TRANSMISSION
PROCESSES :
Streamlining pre and post-claim transmission RCM
processes will allow RCM staff to reduce human error and
complete tasks in a fraction of the time compared to
manual verification and paperwork.
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6. ELIGIBILITY AND BENEFITS VERIFICATION :
Eligibility and benefits verification can be a burden when there are
higher patient volumes each day. Front office staff cannot
concentrate on this and assist patients simultaneously.
Streamlining the eligibility and benefits process in hospitals and
medical groups can obtain eligibility and benefits information specific
to the specialty including out-of-pocket expenses for 100s of patients
within 5mins. This data can be forwarded through the internal
communications system. To the front office so that they can present
the information to patients and providers during visits
PRIOR AUTHORIZATION SIMPLIFICATION
Obtaining prior authorization is a tedious and time-consuming
process. Usage of automated systems which can fill the
authorization forms for you and send the documents electronically is
the best approach our automation systems provide you. It will
indicate if the application is accepted and the current status whether
it is approved or denied are all shown in our prior authorization
automation system.
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7. CHARTS AND CODING ANALYSIS
The interconnected platform allows the medical records department in the
clinic/hospital to obtain coding reviews by forwarding the charts to the RCM coding
team so that they can be analyzed before submitting the claims to avoid coding
errors both in CCI edits and payer end edits.
CHARTS AND CODING ANALYSIS
The interconnected platform allows the medical records department in the
clinic/hospital to obtain coding reviews by forwarding the charts to the RCM coding
team so that they can be analyzed before submitting the claims to avoid coding
errors both in CCI edits and payer end edits.
EOB TO ERA CONVERSION
Most insurance companies have electronic payment methods where the data is sent in
EDI ERA format. Other payers like TPAs, IPAs, Auto Liability, and Worker’s
compensation send out manual checks and EOBs which are overlooked in the mail
room. These documents are converted to ERA format through our EOB to ERA
conversion automation system. This allows less time in consolidating the manual
paper records and posting them one by one on the EHR. This also gives the
clinic/hospital complete accountability for the other payer’s documents and payments.
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8. PATIENT STATEMENTS AND PAYMENT TRACKING
All RCM processes do not come to an end until the out-of-pocket
expenses such as deductible or copayment are still pending in the
patient balance. Our automated patient statement system will
automatically send patient statements through email, text messages,
or mail. Most patients like to pay their bills online and the payment
pathway link is included in these statements, allowing the patient to
pay directly credited to the clinic/hospital’s bank account.
We have created proven and efficient methods that multispecialty
hospitals can function better without any hassle and financial burdens.
BillingParadise and our experts have created a well-performing RCM
workflow that involves both manual staff and automation creating
harmonious multispecialty RCM operations. Reach out to our RCM
excerpts to find out more!
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9. CONTACT US
+1 888-571-9069
inquiries@billingparadise.com
BillingParadise 24x7 INC
53 Emerald Road,
Robbinsville, NJ 08691.
United States.

10. THANK
YOU