Service level	Detail	Frequency	Core Medical Billing	Elite RCM & Insights	Hybrid
Consulting Design
Business Analysis	Financial Assessment	First 90 days	-
	Front Office Workflow Discovery, Assessment, & Design Plan	First 90 days	-
	Back Office/Clinical workflow Discovery, Assessment, & Design Plan	First 90 days	-
	Operations Discovery, Assessment, & Design Plan	First 90 days	-
Quality Review	Coding Assessment	First 90 days	-
	Denial Management Assessment	First 90 days	-
	Compliance Assessment	First 90 days	-
Systems Analysis	eHR/PM database Optimization	First 90 days	-
	Clearinghouse Assessment	First 90 days	-
	3rd Party system Assessment	First 90 days	-
Key Performance Indicators	Qulaity KPIs	First 90 days	-
	Revenue KPIs	First 90 days	-
	Production KPIs	First 90 days	-
	System KPIs	First 90 days	-
	Operation KPIs	First 90 days	-

RCM Pre-Go Live
RCM Pre-Go Live	Revenue Cycle Assessment	Impl	-
	Insurance AR Assessment	Impl	-
	Patient AR Assessment	Impl	-
	Workflow Mapping	Impl	-
RCM implementation	Vendor Performance KPIs	Impl	-
	Revenue Projections	Impl	-
	PM/eHR file build	Impl	-
	Staff training (Hrs TBD)	Impl	-
Clearinghouse validation	Enrollment coordination	Impl	-
	EDI Set up	Impl
	Patient Payment estimator (training and coordination)	Impl	-
Eligibility Set-up and Validation	Setup and configure nightly eligibility verification process in software	Impl
	Confirm successful eligibility verification run	Impl
	Verify that applicable carriers are added to eligibility receivers	Impl
	Review eligibility verification exceptions report	Impl
Claim Creation Set-up and Validation	Setup and configure auto claim creation process in software	Impl
	Attach appropriate medical records or other required documentation	Impl
	Confirm successful claim creation job	Impl
	Address exceptions and create manual claims as needed	Impl
ERA Set-Up	Setup and configure auto ERA import process in software	Impl
Revele Pay	Set-up mapping	Impl
	Set-up escalation plan	Impl
Work Comp Set-up and Validation	Setup, Configure, Train Case Management for Work Comp	Impl
	Services Provided Onsite	Impl	-
	Services Provided Remotely	Impl

Coding:
Coding Review	Verify E/M new vs established patient	D / AN
	Review and revise modifyers as necessary	D / AN
	Review and revise modifyers as necessary	D / AN
	Verify correct diagnosis linkage	D / AN
	Verify correct number of units if applicable	D / AN
	Resolve any Code Correct exceptions	D / AN
	Resolve any rules engine exceptions	D / AN
	Mark claim as submission ready	D / AN
Coding Quality	Analyze claim, medical record, EOBs and actions taken on claim to ensure quality of work	D / AN
	Prepare audit results report	D / AN
	Provide corrective training to staff based on audit results	D / AN	-

Claim Submission:
Batch Verification at Clearinghouse	Reconcile and verify batch received and processed at the clearinghouse	D / AN
	Correct errors causing submission issue	D / AN
	Submit any unprocessed batch	D / AN
	Submit any missing batch	D / AN
EDI Rejections	Process rejection report from clearinghouse	D / AN
	Resolve rejected claims	D / AN
Auto Claim Submission	Confirm successful claim submission job	D / AN
	Resolve any claim submission exceptions or errors and resubmit	D / AN
Occupational Medicine Invoicing	eCW setup, configuration, training for Occ Med	D / AN	-
	Generate and send payer invoice monthly	D / AN	-

Claim Adjudication:
Auto ERA Downloads	Verify auto ERA import completed	D / AN
	Obtain verification EFT received by the client	D / AN
	Resolve any mismatch errors	D / AN
Reconcilliation	Verify that all charges have been created	D / AN
	Verify the all payments have been posted	D / AN
	Prepare balance and reconciliation reports	D / AN

Payment Posting:
Auto Posting	Auto post ERAs	D / AN
	Complete balancing and reconciliation report	D / AN
Lockbox / eBridge Payments	Manually post payments from EOBs	D / AN
	Manually post payments from patients	D / AN
	Complete balancing and reconciliation report	D / AN
Unposted Payments	Allocate unposted patient and scanned EOB payments - Revele Claims only	D / AN
	Verify that all payments have been posted prior to month end	D / AN
NOP (Not our Patient Log)	Maintain NOP Log	D / AN
	Provide NOP log to client	D / AN
	Investigate and issue refund request when applicable	D / AN
ePayments	Process ePayment report from eCW/Vendor Portal	D / AN
	Post payments in eCW	D / AN
	Run epayment reports from ePayment Vendor Portal and eCW for balancing	D / AN

Accounts Receivable (AR) Management:
AR & Denial Management	Address denied claims (24-48 hours)	D / AN
	Investigate reason for denial	D / AN
	Assign claim to appropriate department for correction	D / AN
	Resubmit corrected claim	D / AN
	Create dated follow up task to check status of new claim	D / AN
	Payer specific Corrective Action & client education	D / AN
	Proprietary denial resolution technology	D / AN
	AR Timestamped for visibility and proof of timely filing	D / AN
Appeal	Provide formal written appeal with payers for claim adjudication	D / AN
	Electronic appeals on >900 payer specific appeal forms with attachments, templates and proof of timely filing	D / AN
	Batch appeals for up to 100 claims at a time	D / AN
AR Management - Unresolved Aged Claims	Review unpaid aged claims at appropriate days past DOS	D / AN
	Assign claims to proper follow up team member	D / AN
	Review EOB for denial or correspondence	D / AN
	Correct claim as necessary	D / AN
	Resubmit revised claim as reopening, reconsideration, corrected claim or appeal	D / AN
	Payer specific edits	D / AN
	Electronic automated payer follow up on claims status inquiry based on payer payment turn around time. (Payer specific follow up timelines)	D / AN

Patient Billing and Collections:
Patient Credit Balances	Analyze patient account for proper posting	D / AN
	Transfer applicable credit to open patient balance claims	D / AN
	Review account for small balance, bad debt and/or collection amounts, reverse adjustment and transfer payment	D / AN
	True patient credit add to refund request report	D / AN
	Submit refund request report to the client	D / AN
	Post refund when client verifies refund sent to patient	D / AN
Collections	Review accounts to verify that number of patient statements and the number of days have been reached per client protocol.	D / AN
	Send formatted accounts file to collection agency	D / AN
	Post collection agency payments to correct account	D / AN
Patient Accounts	Create toll free line for patients with billing questions	D / AN	opt
	Manage telephone call center for patient billing questions	D / AN	opt
	Provide support and information to patients regarding billing questions	D / AN	opt
	Provide billing documentation to patients and third parties upon request	D / AN	opt
Revele Pay	Patient Pay Platform	D / AN
	Patient initial escalation	D / AN
	Patient escalations to Patient financial services	D / AN	opt

Financial Reporting and Analysis:
Create month end reports	Provide necessary Canned Month end reports from eCW	D / AN
	Process necessary custom reports from eCW and 3rd party platforms	D / AN	-
	Import required data into Revele proprietary performance report package	D / AN	-
CST Client reporting engagement	Monthly external Client calls	D / AN	-
	Monthly Internal Dashboard Assessments	D / AN	-
	Provide RCM opportunities assessment	D / AN	-
	Electronic version of Month End Dashboards along with RCM Recommendations	D / AN	-
	Coding E&M Bell Curve	D / AN	-
	Weekly KPI Reporting	D / AN	-
	Daily KPI Reporting	D / AN	-
	Scorecard review and assessment	D / AN	-

Account Management
Client Engagement Group	Client Relationship Manager	D / AN
	Client Services Representative - Daily Communication	D / AN
	Coding Resource Consultant	D / AN	-
	RCM Systems and Training Specialists	D / AN
	Patient Services / Revele Pay	D / AN	opt
Training & Education	Annual CPT Update - Specialty Specific	D / AN	-
	Annual ICD 10 Update - Specialty Specific	D / AN	-
	Payer changes/requirements (state & specialty specific)	D / AN	-
	Coding audits	D / AN	-
	Clinical staff training (hrs cap)	D / AN	-
	Front desk system training (hrs cap)	D / AN	-
Industry peer review	Taxonomy driven E&M Bell curve	D / AN	-
	Taxonomy revenue performance	D / AN	-
	eHR Optimization	D / AN	-
	Clinic Workflow optimization	D / AN	-
	PM Workflow optimization	D / AN	-
Production Performance	Revenue opportunities based on volume	D / AN	-
	Revenue opportunities based on Payer mix	D / AN	-
	Revenue opportunities based on Denial management	D / AN	-
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RCM Partnership Service Levels

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