Insurance Mitra: Streamlining Revenue Cycle Management For 'Healthy' Bottom Line

Pramod MJ, DirectorRight from the moment a patient makes an appointment to see the physician, every financial element of the patient's care at every step is tracked by the healthcare providers. For instance, medical billing software enables staff members to quickly execute a myriad of important tasks. The software is built to be capable of streamlining a number of tasks. It can verify insurance coverage and determine co-payments before the patient arrives; send claims with specific treatment codes to insurers once the care protocol is determined; and bill the client for any remaining balance following the appointment.

Revenue cycle management (RCM) describes the combined administration of these essential financial processes. The field is one of the core components of health information management (HIM), which also covers electronic health records (EHR) and patient privacy management methodologies.

Health care leaders have traditionally relied on disparate administrative and clinical functions to optimize the revenue cycle from beginning to end. Revenue Cycle Management (RCM) includes all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

New Delhi based IM Health Consultancy Services LLP branded as Insurance Mitra is one of India's leading hospital revenue cycle management company that offers total backend healthcare solutions to the hospitals.

With a team of 50+ accomplished insurance, healthcare and TPA professionals and management graduates, Insurance Mitra is able to provide quick, focussed and workable solutions to clients with exceptional success rate, whilst maintaining strong and cordial relationship with their debtors.

`Professional courtesy is a vital ingredient' is a pillar on which Insurance Mitra builds its success stories. "We believe that sustained contact with a debtor is the only solution", says Pramod MJ, Founding Director, Insurance Mitra. The staffs at Insurance Mitra are highly trained and fully understand the complexities of the healthcare revenue cycle management. More so, Insurance Mitra's recovery specialists have acquired years of experience in various industries which allows delivering optimum results at every stage of the recovery cycle.

Insurance Mitra is on a mission to redefine Hospital Debt Recovery & Claim Management Services and deliver long term benefits and measurable value to the customers.

Expediting Revenue Cycle Management
On its quest to achieve the aforementioned vision, insurance Mitra offers a host of RCM solutions. The organization provides comprehensive custom collection and receivables management solutions to hospitals that already possess some type of collection or receivables management platform. At the same time, every service that Insurance Mitra offers is meant to compliment and add value to the existing processes of hospitals.

"By utilizing our services, hospital will be able to focus on their core business segments and leverage their efforts resulting in greater efficiencies", assures Pramod.

Insurance Mitra possesses a dedicated team of professionals providing collection & receivables management solutions to hospitals. This dedicated legion of professionals offer the required manpower support for a plethora of tasks including laisoning, auditing, scanning, uploading, submission, handling all queries, submission of payment vouchers, and reconciliation of paid claims. So to say, Insurance Mitra has its hands dipped in every
essential part of the process. As the Director says, "We do all that it takes". Besides, the firm signs a separate SLA along with its agreement with client to monitor the process performance.

Elaborated Look At The Quintessential Services
Credit Billing: Pramod says, "Proper Coding is the magic trick to get claims paid on first go". Rightly so, Insurance Mitra's team of experts based at the client's hospital premises ensure that billing is done in a professional manner. Diagnosis, procedure codes and modifiers are applied as per the requirement of the panel. Finally, completed claims go through a secondary assessment to ensure accuracy before submission.

Front Office: The trained staffs manage the front office with support from the back office. The teamcollects necessary information from patients which shall be processed through the back office. Insurance Mitra also places dedicated manpower at the hospital to manage front office.

Claim Auditing & Bill Docket Preparation: It is very important to have a maker checker concept to avoid deductions / excess billing. Insurance Mitra has professionals on the panel who audit claims to ensure that documentation is complete in all respects as well as chances of unjustified deductions are bare minimum. This, in turn, helps in steering clear of unnecessary revenue loss to the hospital.

Claim Upload & Submission: It is only obvious that timely upload & submission of claim translates to timely claim payment. Insurance Mitra team ensures claim upload & submission to the respective panel in 7 days or as per the requirement of the panel.

Query Management: With claim auditing, chances of query (NMI) is minimal. However, effectively managing the query is a very important aspect in timely payments. Insurance Mitra employees download the query details and prepare apt responses on behalf of the hospital. This team of query handlers ensure the query is responded to within the timelines specified by the Panels.

Insurance Mitra is on a mission to redefine hospital debt recovery & claim management services and deliver long term benefits and measurable value to the customers

Payment Reconciliation: Insurance Mitra also collects the daily ECS received details from finance to reconcile the claims. ECS reconciliation statement is given weekly / bi-monthly to the hospital for accounting purposes. A complete reconciliation statement along with deduction analysis is provided to the hospital to maintain accurate and timely settlement of claims.

Post Claim Analysis: A detailed TAT analysis is prepared on a monthly basis to understand the reason for delay in claim processing, if any, or to know the details of deductions. This deduction analysis is then submitted to the management along with recommendations from the Insurance Mitra's team on the changes to be implemented in the billing system to avoid similar deductions in future. This helps to ensure minimum deductions and maximum revenue to the hospital.

Reporting & Monitoring: Insurance Mitra ensures timely tracking of all claims through dashboards at every stage to monitor the movement of claims in all panels. More so, separate reports / dashboards are provided to the management keeping them well informed about the process' progress and assist in taking timely decisions.

A Vision To Transform Claims Management For Healthcare
Insurance Mitra has always practiced and continues to maximize recoveries quickly at low cost by delivering technology enabled recovery & claim management solutions. This therefore remains, along term objective for Insurance Mitra to make avail for its client maximum values through maximum recoveries, cost savings, enhanced productivity with highest standard of quality, continuous process improvement and cutting edge technology. "We deliver value for money through our proven flexible and transparent delivery and engagement model. We believe in building long term relationship and long-lasting strategic partnership", concludes Pramod. Carrying such goals in the long run, Pramod and his firm, Insurance Mitra is looking toward a promising future. Insurance Mitra staffs' sufficient experience and expertise are an added value that will certainly help hospitals in transforming their claim management.

Streamlining Timely recovery of claims from following panels across India: Insurance Companies or Third Party Administrators (TPAs) - Third Party Administrators (known as TPAs) are firms that provide administrative services in the health insurance field. In most cases, TPAs provide various services like claims processing, premium collection, underwriting, etc. In certain cases, they may also provide customer service on behalf of an insurance company.

Government Panels - This segment includes CGHS, ECHS, ESIC, DGEHS, Other State Govt. Schemes, Municipal Corporation Schemes, Ayushman Bharat, Northern Railway, North Central Railway, etc.

Public Sector Undertakings (PSUs) & Private Corporate - Insurance Mitra facilitates recovery from Public Sector Undertaking (PSU) i.e. Government owned corporation or a company in which Central or State Government has more than 51% share.