RCM Panda

Welcome to RCMPanda

RCMPanda services are designed and managed by experts in healthcare business processes as well as certified in Medicare billing program. With deep experience in working with all different specialties, insurance companies, payment gateways, clearing houses as well as healthcare IT technology companies we bring you ONE STOP SOLUTION for your Medical Office collections. We strongly believe that we can increase your business profitability by REVENUE CYCLE ENHANCEMENT and cutting down the operating costs.

We also provide Tailored Billing Solutions, Virtual Assistant Services, support with MACRA/MIPS and Credentialing. We strongly partner with various Healthcare IT providers and promote EHR and PM solutions.

We strongly believe that we can increase your business profitability and cut down the operating costs. We are a team of passionate individuals who enjoy working with each other and serve our clients. We are RCMPanda!

RCM Services

Revenue Cycle Management

RCMPanda services provide end-to-end Revenue Cycle Management Solutions that makes healthcare providers to get paid more, faster and cleaner. We have a team of elite professionals who are dedicated, business minded and efficient. We have all the capabilities needed to improve and accelerate your medical billing & revenue cycle management process, so you focus on your patient care and allow us to handle your most critical driver to the financial success.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. While entrusting us with your Revenue Cycle Management, we stay committed to provide you 24/7 support, dedicated point of contact, accessibility to reports and dashboard so you have complete visibility of your financial health. Our staff of expert billers handles your back-office operations using our own application or directly through your EHR application, securely and accurately.

It has become crucial for healthcare providers to take utmost care while coding claims, because payers have become highly vigilant in adjudication and reimbursement of claims. Our team of experts would work hard to achieve 98% first-pass acceptance ratio on your claims.

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How RCMPanda will do it?

  • Patient eligibility and benefits are verified prior to check-in
  • Patient documents or superbills or EMRs transmitted by client are fetched
  • Documents are assessed by coders for completeness, quality and readability
  • Diagnosis, procedure codes and modifiers are applied as per insurance guidelines
  • Certain codes are modified to meet the payer specific requirement or specification
  • Completed claims go through a secondary assessment to ensure accuracy before submission
  • Clean claims are then submitted electronically on time
  • Claim submission is confirmed real-time to ensure timeliness
  • Electronic Remittance is applied and reconciled against each claim
  • Denials are corrected and resubmitted real-time
  • Aggressive follow-ups on older account receivables
  • Patients are electronically invoiced on monthly basis
  • No adjustment/write-off policies tolerated

Virtual Assistant Services

Our vision is to help medical offices reduce their operations costs to increase business profitability as well as to focus more on patient care. Our team of experts with good communication skills is geared up to provide complete medical office assistance virtually.

Our services include:

  • Appointment Scheduling
  • Patient Billing Calls
  • Answering Services
  • Patient Communications
  • Provider Assistant

Tailored Billing Solutions

Tailored medical billing services options allow you to outsource as much or as little as you require. Outsourcing your medical billing and coding plus collections can free up resources and reduce administrative costs of your practice. Allow your providers to focus more on care and expanding the practice. Our clients used RCMPanda customized medical billing services options to help grow their business:

  • Credentialing and Contracting
  • Account Receivable Follow-up
  • Denials and Appeals Management
  • Eligibility Verification with Payers
  • Referral Submission & Tracking
  • Electronic remittance and payment posting
  • Demographics and Claims Entry/Submission/Reconciliation

You may select one or more of the options. Or, start with our complete RCM solution…

MACRA / MIPS

What

CMS is required by law to implement a quality payment incentive program, referred to as the Quality Payment Program, which rewards value and outcomes in one of two ways: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Under MIPS, clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule.

Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost. We designed MIPS to update and consolidate previous programs, including: Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).

How it Works

There are four performance categories that make up your final score. Your final score determines what your payment adjustment will be. These categories are:

Quality

This performance category replaces PQRS. This category covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups. You pick the six measures of performance that best fit your practice.

Promoting Interoperability (PI)

CMS is re-naming the Advancing Care Information performance category to Promoting Interoperability (PI) to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). This performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.

Improvement Activities

This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.

Cost

This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. Beginning in 2018, this performance category will count towards your MIPS final score.

Why

MIPS was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.

When

The MIPS Performance Year begins on January 1 and ends on December 31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year. For example, program participants who collected data in 2017 must report their data by March 31, 2018 to be eligible for a payment increase and to avoid a payment reduction in 2019.

Credentialing

Credentialing essential for new practices as well as existing practices, it is an ongoing process and must be redone every 3 to 5 years. It is critically necessary for providers to stay in-network with desired carriers to receive reimbursements. Most health insurance companies require this process including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.

RCMPanda submits enrolment applications and the associated documentation on behalf of the provider organization to keep its physicians’ records updated. These include their medical license, malpractice insurance, and DEA. Additional information necessary to complete credentialing

  • Medical School information
  • Internship/Residency/Fellowship’s Information
  • Board Certifications
  • Provider’s CV

RCMPanda eliminates the issues surrounding provider enrolment and physician/non-physician credentialing. We take care of the expansive paperwork, eliminate confusion and follow-up with insurance companies and continue until the job is finished.

Our services include:

  • Commercial insurance provider enrolment and credentialing (i.e., Aetna, Anthem, BCBS, CIGNA, TriCare, Humana, UnitedHealthcare and many more!)
  • Medicare and Medicaid provider enrolment and credentialing
  • Medicare revalidation
  • CAQH registration
  • NPI registration (Type I and Type II)

EHR and PM Solutions

Our technology expertise is our strength. With vast experience working with various healthcare technology companies, we bring you fully certified and fully featured system for providers as well as patients. Technology which could be used by medical offices, physicians, PAs, NPs, MAs, managed care, front office staff, billing staff, and even patients!

Our technology solutions are tailored for all different specialities considering their workflow and business models. Our solutions are cloud based and are accessible from any device any where using the internet browser.

Products we offer:

  • Cloud based EHR system
  • Integrated PM system
  • Patient-Portal