Essential RCM

Essential RCM, offered by edgeMED Healthcare, is a revenue cycle management service designed to streamline and optimize the revenue cycle for medical practices and health systems. According to the vendor, this solution is tailored for various entities such as independent physician practices, health systems, state/federal entities, Accountable Care Organizations (ACOs), and medical homes. Essential RCM serves professionals in the healthcare industry, including physicians, hospitals, clinics, healthcare systems, and government healthcare organizations.

Key Features

Physician credentialing: According to the vendor, this feature aims to maximize revenue by ensuring accurate and up-to-date provider credentials through streamlined credentialing processes.

Scheduling management: The vendor claims that this feature improves the patient experience and drives revenue by efficiently scheduling appointments, managing patient flow, and integrating scheduling with billing and claims management.

Eligibility verification: The vendor states that this feature reduces claim denials and streamlines the verification process by verifying eligibility and benefits with automated tools, leading to improved upfront collection of patient responsibility.

Charge capture: According to the vendor, this feature aims to achieve a high first-pass payment rate by accurately capturing and documenting all billable services and procedures, minimizing coding errors and maximizing reimbursement.

Medical coding: The vendor claims that this feature optimizes reimbursement by ensuring accurate and compliant coding for each patient encounter, staying up-to-date with coding guidelines and regulations, and reducing coding errors and claim denials.

Claims submission: According to the vendor, this feature prevents errors before submission and reduces claim denials and rejections by validating claims for accuracy and completeness, and submitting claims electronically for faster processing.

Payment processing: The vendor states that this feature allows analysis of payment trends, identification of optimization opportunities, streamlining of payment posting and reconciliation, and improvement of cash flow by efficiently managing payment processes.

Patient payments: According to the vendor, this feature simplifies patient billing and collections processes, increases patient satisfaction by offering convenient payment options, and enables quicker, cost-effective patient payments.

Audits and controls: The vendor claims that this feature helps identify and resolve billing and compliance errors, conduct regular audits to ensure accuracy and compliance, implement internal controls to prevent fraud and abuse, and mitigate financial and legal risks.

Denial management: According to the vendor, this feature aims to raise reimbursement rates by identifying root causes of claim denials, streamlining denial management processes for faster resolution, and improving revenue cycle performance by reducing denied claims.