Join our successful Team
Miami RCM LLC provides comprehensive medical billing and coding services to physicians and ambulatory surgery centers in U.S. healthcare, managing the revenue cycle for multiple physicians and specialties across the country.
We founded this company to allow private practices to focus on their patients and grow their business while we take care of the complex billing processes. We work as your back office and take a partnership approach because we believe growth and success are mutual. We are adept at handling complex medical billing, coding, compliance, automation, and back-end operations for practices ranging from individual physicians to large practice groups.
Our strength is our core team, which collectively has more than two decades of valuable experience managing the revenue cycle in U.S. healthcare, and our passion for keeping up with current industry trends and practices to be compliant.
We are proud to help physicians start their new practice, where they need great help understanding the reality and advising them to make their first business decisions that will be the foundation for their future growth. This includes helping them select an EHR and practice management system, get into the network of various insurances, set up workflows for billing, and improve patient relations.
If you have an established practice, you can contact us to perform a free billing audit of your practice’s performance. We specialize in performing these billing audits quickly and efficiently to help you improve your processes, reduce costs, and increase efficiency.
Our Services
We provide comprehensive medical billing services that include
Medical Billing
We value and are committed to compliance and integrity. In highly regulated industries like healthcare, it is critical to know current laws and regulations, review policies and monitor risks. With deep expertise and a partnership approach, we are a global best-in-class culture that operates with integrity and demonstrates quality and compliance as a competitive advantage.
Charge capturing and demographic entry: We manually enter patient demographic data and charges into the system using Excel if the system cannot receive them automatically.
Eligibility verification and prior authorization: We verify patient’s eligibility and benefits and provide a quick summary for your front office staff to communicate with the patients, also, we get prior authorization for services that require one from the insurance.
Accounts receivable management: We make sure we get a response from the insurance companies within 30 days from the time we submit the claim, if not our team will be following up with the insurance to make sure the claim is received and is being processed. Timely follow-up of claims will be our priority to avoid timely filing denials and receiving payments on time which is the key to running any practice. If there is a stagnant AR, we also provide strategies to recover it quickly.
Denials and rejections management: We have created a best system for monitoring the denials and rejections and ways to avoid repetitive ones by working with your staff, our internal staff, doctors, etc. in a timely fashion. The result will be reduced denials no repeated errors and greater turnaround time of receiving payments.
Payment posting: We post payments that are both from the patients and the insurance, we process EOBs (paper explanations of benefits received at the office) as well as the ERA (electronic remittances received through your clearinghouse) and make sure they match with what you received in your bank account. We also make corrections, reposts, or payments in case there are corrections, recoupments, overpayments, etc. involved.
Patient statements: We audit the patient balances and make sure they are valid before sending patient statements to have a better patient relationship and avoid unnecessary billing phone calls.
Medical coding
Coding healthcare services is an increasingly complex discipline that requires constant attention to regulatory changes, patient care and clinical documentation. Our unique combination of talent, technology and proven expertise increases efficiency, provides greater transparency and strengthens compliance and profitability.
Medical Coding: We perform medical coding based on medical records and ensure that the appropriate procedure, diagnosis, and modifiers are indicated on the claim. If your practice management system is capable of adding codes on its own, our team of coding experts can make additional corrections to ensure ICD-10 compliance, reduce the coding backlog AR, reduce claim submission time, improve quality of care, get paid for all the services you provide and improve provider documentation, which can prove to be a critical advantage if we ever need to dispute claim denials.
Medical coding audit and compliance review: Our medical coding auditors perform deep-dive into the coding portion of revenue cycle to mitigate risk by facilitating accurate billing of documented procedures. Helps you streamline your operations and improve overall billing integrity by training your staff on coding processes. Our team improves your coding accuracy to increase reimbursement and reduce compliance and audit risks. Gain insights into your organization’s coding and clinical documentation performance by assessing processes and performance by provider and department.
What's covered in the audit? - Audit of incorrect use of CPT codes, correct place of service, incorrect use of modifiers/missing modifiers, audit of incorrect diagnoses, correctness of operative reports, medical documentation to make them appropriate for the procedure, audit to identify bundling or clustering problems, make recommendations based on audit results
Medicare quality reporting: We help qualified Medicare providers and practices establish the Medicare Quality Reporting System, also known as the Provider Quality Reporting System, and ensure that all relevant measures are reported to Medicare. This not only avoids penalties, but also helps to obtain additional reimbursement when appropriate.
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Credentialing and EDI
Credentialing with commercial and government payers can sometimes be very difficult, as a lot of information needs to be added to forms and insurance portals. Our team of experts has hands-on experience dealing with the paperwork and working with insurance credentialing departments to meet complex requirements. On the other hand, EDI can be a real game changer as it can drastically reduce cycle time.
Credentialing: Our expert team reviews specific insurance networks or an assessment of the major payers in your area. We gather all required documentation from the provider and contacts the insurance companies to initiate the application process through online form-filling portals or through faxes. Once submitted, we do a timely follow-up with payers to ensure they have been received and is being processed. Also, we provide status update until the effective date of enrollment is determined and a contract is received and executed so that the provider can begin submitting claims.
Medicare and Medicaid: Our team has expertise in credentialing providers with federal and government payers such as Medicare and Medicaid across different states. We also provide re-credentialing services for government payers to keep the provider information updated with the insurance systems based on the effective date.
EDI enrollments and Enhancements: We are ensuring that EDI filings are completed with the clearinghouse and payers to ensure that the majority of claims are submitted electronically, which directly impacts timely claims processing and consistent revenue. We are also working to ensure that all payments are received as electronic funds transfers and electronic remittances through your clearing house, creating a paperless environment.
Billing audit and reporting
Whether you use an outsourced biller or an internal team to manage your billing and coding activities, it is always recommended to have an external auditor review your processes to ensure you are compliant and have a robust billing workflow that not only improves efficiency, but also sets your quality standards high and creates a foundation for future growth.
Billing performance audits: We do comprehensive billing and coding audits that are essential for ensuring the accuracy and compliance of your internal revenue cycle management (RCM) processes. This will help you identify and correct errors, improve coding quality, reduce denials and rejections, and optimize reimbursement using CMS guidelines, and AMA standards. You may be surprised with the results of the audit as our feedbacks and inputs we provided to our clients have helped them make impactful business decisions and grown their practice exceptionally.
Reports and Business Analytics: We believe in data-driven process improvement and provide timely reports. This includes key performance indicators for your practice measured daily, weekly, monthly and quarterly. We also provide ad hoc inquiries that are very specific to your situation, such as whether your insurance companies are paying as contracted, which procedures are profitable, whether your providers or staff are performing as expected. Knowing your numbers is key to a successful business, and we are here to help.
Miami RCM LLC,
1712 SW 2ND AVE., PH 9,
MIAMI, 33129
954-607-2433
847-502-6887