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Revenue Cycle Management

A streamlined process to make sure claims turn to payments and keep revenue flowing.

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1. Data Capture and Review

Includes obtaining data from the practice software. We can work with any software.

  • Review of coding and billing data
  • Insurance verification
  • Prior auth capture
  • Charge entry

2. Claim Submission

Typically takes place within 24 hours of our receipt of complete billing information.

  • Claims are submitted electronically or by paper if that is the payer’s requirement.
  • We submit all primary, secondary, and tertiary claims.

3. Payment Posting and Reimbursement Review

We review all remittance advice to ensure capture of all available reimbursement.

  • All EFTS will be routed to the practice’s bank account.
  • We provide you with access to all remittance advice.
  • We post all copays and patient payments to the patient’s account to maintain accurate records.

4. Claims Resolution

Payers work hard to keep their money, and we fight for your reimbursement.

  • We use all available methods (payer portals, phone calls, provider representatives, patient involvement and sometimes even insurance commissioners) to resolve claims in the most efficient manner possible. Our goal is to get your reimbursement in the door as soon as possible and speed up your cashflow.
  • The resolution process begins upon receipt of a denial or partial payment, or at the time reimbursement is deemed overdue based on payer’s standard processing time.

5. Send Patient Statements

We send these to your patients on the 15th of every month.

  • The statements contain a 1-800 number for your patients to call and speak with your Sceptre Revenue Cycle Specialist to answer any questions they may have.
  • In the event you use a collection agency, we will coordinate the submission of patient bad debts with the collection agency.

6. Charge and Reimbursement Reconciliation

This is an integral part of our month-end processes. We collaborate with you to create a process to capture and verify the capture of all your work. Additionally, we reconcile the receipts in our billing software to the deposits made to your practice bank account and make sure those two balances match each month to the penny.

7. Meaningful Reporting

We provide a client dashboard that provides timely charge and reimbursement data at a glance. In addition to the dashboard, we provide a suite of reports that are accessible to you at any time and can be run on demand.

  • Our reports can show you your charge and payment data sliced and diced in several ways, including by location, provider, charge category and for any given period of time.
  • During your onboarding process, we will work with you to design a reporting package that meets your needs and provides you with the data you need to make good financial decisions for your practice.

8. Collaboration

We value the collaboration of our clients, and we know our deliverables are at their best when we have scheduled meetings and maintain open dialogue with our clients regarding reimbursement, accounts receivables and changes in payer policies and regulations.

  • Depending on the client’s needs, we can meet weekly or monthly with the client’s key staff to discuss any RCM needs or action items.