ABOUT US

PRS Healthcare provides comprehensive Revenue Cycle Management (RCM) solutions, delivering a diverse array of business process services designed to enhance efficiency and optimize financial performance for healthcare providers.

• Documentation : Collect, validate, and store necessary documents.
• Payer Submission : File applications with top payers in their required format.
• Ensure Enrollment : Timely follow-ups to secure enrollment.
• Updates & Re-Credentialing : Regularly update payer documents for recredentialing.

Inadequate verification leads to issues like delayed payments, reworks, and decreased patient satisfaction. Our team efficiently initiates prior authorization requests, securing treatment approvals through online portals and direct communication with payers.

Our precise data processing minimizes denials by ensuring clean claims. Our skilled team accurately registers patient information and selects the correct insurance codes from the master list.

 Our AAPC and AHIMA-certified coders take care of specific Specialties and ICD-10 coding. They assist in documenting with appropriate CPT and ICD codes and Modifiers.

Key aspects of claim scrubbing include :

• Verifying patient information – Ensuring details like name, date of birth, insurance ID, and policy number are correct.
• Correct coding – Checking that procedure (CPT, HCPCS) and diagnosis (ICD) codes are accurate and match the services provided.
•  Ensuring compliance – Confirming that the claim follows payer-specific guidelines and policies, including coverage rules and medical necessity.
• Checking for duplication – Avoiding submission of duplicate claims for the same service.

By scrubbing claims before submission, healthcare providers reduce the risk of claims being denied, leading to faster reimbursement.

Our team efficiently processes both manual and electronic charge entries from EHR/EMR systems.

Payments received via ERA/EOB are posted within 24-48 hours, with daily reconciliation of reports. Denials are promptly captured and forwarded to the Denial Analysis team.

Claim Denials are analyzed carefully, and the root cause is defined for each problem. It is then escalated to the concerned teams to make sure the Denials are fixed & also ensured they don’t recur in the future. Denial analysis is shared with the client once a week.

PRS Healthcare’s objective is to improve your cash flow by reducing days in A/R and improving profitability by increasing your collections ratio. We analyze all underpayments and work with stakeholders to prevent them in the future.

Patient AR (Accounts Receivable) refers to the outstanding balances that healthcare providers are owed by patients for medical services rendered. These unpaid balances typically result from patients not paying their portion of the bill after insurance, such as co-pays, deductibles, and coinsurance, or due to patients being self-pay (uninsured).

Patient Collections is the process of recovering these unpaid balances. This involves a series of steps to collect payments from patients, including:

• Billing: The healthcare provider sends an invoice to the patient for the amount they owe after insurance.
• Follow-up: If payment is not received within a certain timeframe, the provider may follow up with reminders.
• Payment Plans: Sometimes, patients are offered installment plans to pay off their balance over time.
• Third-party Collection Agencies: If the provider is unable to collect the amount directly, the debt may be referred to a collection’s agency.
• Legal Action: In extreme cases, legal action may be taken to recover the debt.

Patient AR and collections are a critical part of the healthcare revenue cycle management (RCM), ensuring that providers receive the payment they are owed for services delivered.