SERVICE & PRODUCT OFFERNING

Revenue Cycle Management (RCM)

The Raw Group specializes in executing the entire billing process for healthcare providers, from start to finish. Learn more below about our RCM basic and premium product offerings that can help your facility streamline its billing process.

RAW RCM Offering: RCM Basic vs. RCM Premium

Eligibility Verifications, Prior-Authorizations & Referrals

Provider
RCM Base
RCM Premium
Verify patient eligibility and benefits prior to visit or a procedure
Verify patient eligibility and benefits prior to visit or a procedure
Verify patient eligibility and benefits prior to visit or a procedure
Verify patient eligibility and benefits prior to visit or a procedure
Obtain prior-authorizations (if needed) for a procedure and enter into PM System
Obtain prior-authorizations (if needed) for a procedure and enter into PM System
Obtain prior-authorizations (if needed) for a procedure and enter into PM System
Obtain prior-authorizations (if needed) for a procedure and enter into PM System
Obtain referral (if needed) and enter into PM System
Obtain referral (if needed) and enter into PM System
Obtain referral (if needed) and enter into PM System
Obtain referral (if needed) and enter into PM System

   Billing

Provider
RCM Base
RCM Premium
Patient check-in and copay collection
Patient check-in and copay collection
Patient check-in and copay collection
Patient check-in and copay collection
Capture charges from patient encounter data retrieved thru care360 EHR
Capture charges from patient encounter data retrieved thru care360 EHR
Capture charges from patient encounter data retrieved thru care360 EHR
Capture charges from patient encounter data retrieved thru care360 EHR
WebCoder
WebCoder
WebCoder
WebCoder
Scrub encounter data, conforming to use of appropriate modifiers, POS, TOS etc
Scrub encounter data, conforming to use of appropriate modifiers, POS, TOS etc
Scrub encounter data, conforming to use of appropriate modifiers, POS, TOS etc
Scrub encounter data, conforming to use of appropriate modifiers, POS, TOS etc
Missing/invalid encounter data will be communicated to the Provider
Missing/invalid encounter data will be communicated to the Provider
Missing/invalid encounter data will be communicated to the Provider
Missing/invalid encounter data will be communicated to the Provider
Claim rejection management with Provider support
Claim rejection management with Provider support
Claim rejection management with Provider support
Claim rejection management with Provider support
Claim generation and submission to Clearinghouse
Claim generation and submission to Clearinghouse
Claim generation and submission to Clearinghouse
Claim generation and submission to Clearinghouse
Claim acknowledgement reports from the Clearinghouse
Claim acknowledgement reports from the Clearinghouse
Claim acknowledgement reports from the Clearinghouse
Claim acknowledgement reports from the Clearinghouse
Claim rejection due to inconsistency in patient/insurance data will be communicated to the Provider and RCM Partner along with the provider will correct the claim for resubmission
Claim rejection due to inconsistency in patient/insurance data will be communicated to the Provider and RCM Partner along with the provider will correct the claim for resubmission
Claim rejection due to inconsistency in patient/insurance data will be communicated to the Provider and RCM Partner along with the provider will correct the claim for resubmission
Claim rejection due to inconsistency in patient/insurance data will be communicated to the Provider and RCM Partner along with the provider will correct the claim for resubmission

   Payment Posting

Provider
RCM Base
RCM Premium
Post ERAs/paper EOBs
Post ERAs/paper EOBs
Post ERAs/paper EOBs
Post ERAs/paper EOBs
Review payments with appropriate adjustments by conforming to contractual allowables of various payors
Review payments with appropriate adjustments by conforming to contractual allowables of various payors
Review payments with appropriate adjustments by conforming to contractual allowables of various payors
Review payments with appropriate adjustments by conforming to contractual allowables of various payors
Discrepancies found on ERAs/EOBs with respect to incorrect claim processing that has resulted in under-payment or partial denial; follow-up/appeal process will be initiated to compel the Payor to issue correct payment
Discrepancies found on ERAs/EOBs with respect to incorrect claim processing that has resulted in under-payment or partial denial; follow-up/appeal process will be initiated to compel the Payor to issue correct payment
Discrepancies found on ERAs/EOBs with respect to incorrect claim processing that has resulted in under-payment or partial denial; follow-up/appeal process will be initiated to compel the Payor to issue correct payment
Discrepancies found on ERAs/EOBs with respect to incorrect claim processing that has resulted in under-payment or partial denial; follow-up/appeal process will be initiated to compel the Payor to issue correct payment
Denial management
Denial management
Denial management
Denial management

   A/R Management

Provider
RCM Base
RCM Premium
Generate 30 day A/R reports and follow-up with Payors for outstanding claims
Generate 30 day A/R reports and follow-up with Payors for outstanding claims
Generate 30 day A/R reports and follow-up with Payors for outstanding claims
Generate 30 day A/R reports and follow-up with Payors for outstanding claims
Claim denied during A/R follow-up; denial management process will be initiated and appeal would be sent with supporting documents (with Provider support) to overturn the denial
Claim denied during A/R follow-up; denial management process will be initiated and appeal would be sent with supporting documents (with Provider support) to overturn the denial
Claim denied during A/R follow-up; denial management process will be initiated and appeal would be sent with supporting documents (with Provider support) to overturn the denial
Claim denied during A/R follow-up; denial management process will be initiated and appeal would be sent with supporting documents (with Provider support) to overturn the denial

   Patient Billing

Provider
RCM Base
RCM Premium
Patient responsibility including deductible, co-insurance, non-covered services will be billed to the patients by mailing at least two monthly and one pre-collections statements
Patient responsibility including deductible, co-insurance, non-covered services will be billed to the patients by mailing at least two monthly and one pre-collections statements
Patient responsibility including deductible, co-insurance, non-covered services will be billed to the patients by mailing at least two monthly and one pre-collections statements
Patient responsibility including deductible, co-insurance, non-covered services will be billed to the patients by mailing at least two monthly and one pre-collections statements
WebPayer
WebPayer
WebPayer
WebPayer
Provide phone support for patient queries
Provide phone support for patient queries
Provide phone support for patient queries
Provide phone support for patient queries
Accept and process patient payments
Accept and process patient payments
Accept and process patient payments
Accept and process patient payments
Collection Agency support for patient non-payments (Optional)
Collection Agency support for patient non-payments (Optional)
Collection Agency support for patient non-payments (Optional)
Collection Agency support for patient non-payments (Optional)

   Financial Reports and Analysis

Provider
RCM Base
RCM Premium
Generate standard monthly billing and collections reports
Generate standard monthly billing and collections reports
Generate standard monthly billing and collections reports
Generate standard monthly billing and collections reports
Customize CGM WebPractice compatible reports including graphical analysis
Customize CGM WebPractice compatible reports including graphical analysis
Customize CGM WebPractice compatible reports including graphical analysis
Customize CGM WebPractice compatible reports including graphical analysis

   Account Manager

Provider
RCM Base
RCM Premium
Account Manager with e-mail support
Account Manager with e-mail support
Account Manager with e-mail support
Account Manager with e-mail support
Dedicated Account Manager with e-mail and phone support
Dedicated Account Manager with e-mail and phone support
Dedicated Account Manager with e-mail and phone support
Dedicated Account Manager with e-mail and phone support