Optimize Your Revenue in a World of Declining Reimbursement
Measure your success and maximize your bottom line with Alpha Core Healthcare.
Key Components of Revenue Cycle Management (RCM)
Patient Registration & Insurance Verification
- Collecting patient demographics and insurance details
- Verifying insurance eligibility and coverage
- Ensuring accurate entry of policy information to avoid claim denials
Charge Capture &
Medical Coding
- Recording services provided to the patient
- Assigning correct medical codes (ICD-10, CPT, HCPCS) for billing
- Ensuring accurate documentation to avoid claim rejections
Claims Submission
- Preparing and submitting claims to insurance payers
- Ensuring clean claim submission with proper codes and modifiers
- Using Electronic Data Interchange (EDI) for faster claim processing
Payment Posting
- Recording payments received from insurance companies and patients
- Reconciling payments with billed charges
- Identifying underpayments or discrepancies
Denial Management
- Identifying reasons for claim denials (coding errors, missing information, etc.)
- Correcting and resubmitting denied claims
- Implementing strategies to prevent future denials
Accounts Receivable (A/R) Management
- Following up on outstanding insurance claims and patient balances
- Reducing A/R days by ensuring timely payments
- Tracking unpaid claims to minimize revenue leakage
Patient Billing & Collections
- Generating patient statements and invoices
- Providing flexible payment options for patients
- Handling patient inquiries and setting up payment plans if needed
Reporting & Analytics
- Monitoring financial performance and cash flow
- Analyzing trends in denials, reimbursements, and collections
- Identifying areas for improvement in revenue cycle efficiency
Complete End to End RCM Service for Healthcare Institutions
Benefits & Eligibility Verification
BEV is the most crucial part of any RCM cycle. We make sure your patients plan has coverage for the procedure that you are about to perform. This eliminates all eligibility related denials and increases revenue by at least 7-10%.
Coding & Submission
Claims are scrutinized ensuring maximized reimbursements without over-coding which is one of the ways we typically increase clients’ revenue by 10-20%. We maintain a nearly 100% success rate on first attempt HCFA and UB clearinghouse claims with WC (workers compensation) and NF (No Fault) available as well. We stay on top of all latest coding updates.
AR Follow Up
We all know that Insurances will deny claims. Thus AR follow-up is the most critical part of any billing work flow. Accounts receivables follow-up ensures timely turn around of rejections and denials. Here at Alpha Core, we make sure that maximum resources are allocated to the AR follow-up team so that a high number of submitted claims can be timely followed up on to enable quick action and re-working of the denials.
Denial Management
We make sure your AR experiences minimal denials. Our experts have extensive experience in overturning all types of denials, right from medical necessity denials, maximum benefits exhausted, additional documents required, coding related denials, patient benefit related denials, prior authorization issues, EDI issues, our team is adept at resolving and getting the denials overturned with timely, effective, affirmative follow up and extensive appeals.
Appeals / Medical Necessity
We have a separate appeals and reconsiderations team that works closely with the AR team. The team has both pre-set and customizable appeal formats for each and every type of denial. Extensive appeals including the right information, submitted timely can have a huge impact on overturning the most complicated denials effectively.
EOB / ERA Posting
We make sure all your EOB’s ( Explanation of benefits ) and ERA’s ( Electronic remittance advice ) are posted and reconciled daily to ensure an accurate end of day statement for your staff to review and access average growth in revenue. We have a two tier quality system in place, ensuring all postings go through a level 1 and level 2 check before the final reconciliation report is generated
Patient Statements
With patient balances among the largest of owed buckets, successfully collecting their balances after insurance and co-payments is a must. We have what’s needed to help ensure getting every dollar from every patient. We handle patient statements and take calls from patients who have statement questions, also make polite calls to remind patients of their balances using all modes of communication including emails, fax, texts etc.
Revenue Enhancement Meets
We keep our Billing workflow highly transparent with the client. The Billing teams work flow logins are shared with the client for complete transparency. All reports are shared weekly. We organize monthly REM sessions with the client to make sure we lay out a clear road map, going over all aging and revenue reports, showing the client exactly what we have planned to up their collections, thus revenue growth and assessment in the coming quarter.
Do you have Backlogs or Aged AR?
Every practice, laboratory or healthcare institution submitting insurance claims is battling that demon called aged AR or stuck AR. These are insurance denials, rejections and other missing info related claims that you are not able to do much about, due to either being short staffed, your billing company not putting in enough efforts or resources or simply because you have too much on your plate administration wise, that the billing & aged AR took a back seat.
This is money you lost. Money that could have been collected and grown your bottom line.
We have a simple solution for achieving just that. Don’t fire your biller or your billing team. No changes in software and no additional cost to hire us. Just hand over that aged AR to us and let us collect on those un-worked denials and rejections. We get paid when you get paid on that lost/aged AR. Simple.
Our backlog recovery and Aging experts
Our Backlog Recovery and Aging Experts specialize in resolving outstanding claims, reducing aging accounts, and streamlining revenue cycles for healthcare practices. With extensive experience in Revenue Cycle Management (RCM), our team efficiently tackles billing backlogs, accelerates reimbursements, and minimizes financial losses due to aged claims.
By leveraging data-driven strategies, denial management expertise, and a proactive approach, we help healthcare providers recover lost revenue, improve cash flow, and maintain a healthier financial outlook. Whether addressing claim denials, resubmissions, or payer follow-ups, our experts ensure optimized revenue recovery and long-term financial stability for medical practices.
The Proven Approach Our Aged AR Specialists Take
Prepare
- Assess your entire AR for the last 3 years
- Prepare analysis on what is the collectable metric
- Present a quarterly collection plan based on buckets
- Establish up a communication flow with the practice
- Set a monthly progress reporting system with you
Do
- Aggressive AR follow up on aged claims
- Identifying denial reasons and classifying buckets
- Strategizing & prioritizing work flow & timelines
- Aggressive as well as assertive appeals submission
- Identifying patient owed balances and planning retrieval
- Working closely with the credentialing team
- Working closely with the enrollment team – ERA, EDI related issues
We collect what you thought you had lost.
Hospitals are sitting on millions of aged / stuck AR that they have given up on. Give our Aged AR experts a chance to come in, strategize and collect, what’s rightfully yours.
Services
Contact Us
- hello@alphacorehealthcare.com
- (302) 304-8686
- 3524 Silverside Rd, Wilmington, DE 19810, United States
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