Services

Offshore Setup Consultation

Complete support for establishing your RCM operations in US & India.

RCM Summit provides comprehensive consultation services to set up offshore operations in India for healthcare RCM companies. We handle strategic planning, recruitment, infrastructure setup, process optimization, compliance, and performance monitoring, ensuring a seamless and efficient establishment of your offshore center.

RCM Offshore Set Up

At RCMSummit, we build and optimize offshore delivery centers for healthcare RCM companies, fostering sustainable growth through cost-efficient operations and skilled teams. Our approach enhances every aspect of Revenue Cycle Management (RCM), boosting revenue, reducing overhead, and improving performance.

Partnering with RCMSummit for your Global Captive Center or offshore office offers:

Up to 40% cost savings: Reduce expenses with India’s cost-effective, experienced workforce.
A 30% revenue increase: Enhance RCM efficiency to capture revenue faster and more accurately.

As experts in both RCM and offshore operations, RCMSummit is uniquely positioned to help you expand globally while maintaining quality and control. We handle everything from team recruitment and training to technology setup, so you can focus on growth while we manage your offshore delivery center.

Denial Management Consulting

Effective Denial Management is a cornerstone of financial health for healthcare organizations, ensuring that revenue capture is optimized while reducing the administrative burden on providers. Our Denial Management Consulting service, led by industry expert A.J. Johnson, is designed to identify and eliminate the root causes of denials, leveraging a proactive, analytics-driven approach to achieve sustainable results. Root Cause Analysis (RCA) is at the heart of our process, enabling us to uncover the underlying issues behind denial trends and implement solutions that prevent recurrence.

With a focus on both technical and operational aspects, our Denial Management Consulting dives deep into claim workflows, payer-provider contracts, and revenue cycle analytics. By conducting thorough RCA, we assess common denial reasons, pinpoint process bottlenecks, and determine compliance gaps. Our approach integrates best practices in Payment Integrity and patient invoice transparency, ensuring that each denial is addressed at its source. This tailored, preventative methodology empowers healthcare providers to reduce rework, streamline their processes, and improve compliance with payer guidelines.

Our consulting services have a proven track record of recovering millions in underpayments, enabling RCM teams to manage denials more effectively and strengthening payer relationships. Let us help your organization move from reactive denial management to a proactive approach that enhances revenue integrity and supports long-term financial stability.

Steps in Our Denial Management Consulting Process

1. Initial Assessment and Data Collection

We begin with an in-depth review of your current denial management practices, analyzing historical data on denial rates, types, and recovery outcomes. This data collection allows us to understand denial patterns and assess existing workflows, payer contracts, and billing processes.

2. Root Cause Analysis (RCA)

Using Root Cause Analysis, we identify the primary drivers behind recurring denials. This step involves examining common denial reasons, such as incomplete documentation, coding errors, or eligibility issues, and isolating systemic issues in workflows or contract terms that contribute to these denials.

3. Categorizing Denial Types and Prioritizing Issues

We categorize denials based on urgency, financial impact, and recurrence. By prioritizing high-impact areas, we can focus resources on the issues that will have the most significant effect on reducing denial rates and improving revenue.

4. Workflow Optimization and Process Redesign

Based on RCA findings, we recommend process redesigns to prevent denials from occurring in the first place. This may involve updating workflows, training staff, and implementing standardized documentation and coding practices that align with payer guidelines.

5. Implementation of Automated Tools and Reporting

We support the adoption of automation tools, where feasible, to streamline denial tracking and reporting. By automating repetitive tasks and improving data capture, we help reduce errors and ensure consistent adherence to denial management protocols.

6. Payer Communication and Compliance Optimization

To strengthen compliance and prevent denials related to contractual misunderstandings, we review payer-provider contracts and clarify terms. We also enhance communication processes with payers, ensuring timely follow-up on denied claims and fostering better relationships.

7. Monitoring, Reporting, and Continuous Improvement

We establish an ongoing denial management dashboard to track performance metrics, monitor denial trends, and identify new denial types. This continuous feedback loop enables real-time adjustments and keeps your denial

8. Regular Training and Knowledge Transfer

Our consulting includes training your team on best practices in denial management, providing them with the skills needed to sustain denial prevention initiatives long-term. We also offer knowledge transfer sessions to empower teams to manage denial processes independently.

This structured, data-driven approach has proven effective in reducing denial rates, increasing recovered revenue, and enabling a proactive denial management process that supports your organization’s long-term financial health and operational stability.

Offshore Delivery Solutions

At RCMSummit, we help US Healthcare Revenue Cycle Management (RCM) companies achieve growth through tailored performance improvement strategies. Our expertise covers optimizing processes, increasing efficiency, and driving sustainable revenue. Our key services include:

Process Optimization

We analyze and streamline your RCM workflows, implement automation, and enhance productivity across the RCM lifecycle.

Offshore Delivery Solutions:

We build and manage offshore centers in India, offering up to 40% cost savings and a 30% increase in revenue.

Performance Monitoring:

We provide data-driven insights with customized dashboards and real-time reporting to track key performance indicators.

Talent Acquisition:

We help recruit and develop skilled RCM professionals to ensure your team excels in all RCM tasks.

Technology Integration:

We incorporate advanced technologies like AI and RPA to enhance accuracy and efficiency in your RCM operations.

Compliance and Risk Management

We guide you through regulatory compliance and risk mitigation to protect your business and ensure sustainability.

Growth Roadmaps

We create customized growth strategies to improve revenue, optimize cash flow, and expand your business effectively.

RCMSummit is your partner in achieving measurable growth and operational excellence in the global healthcare RCM landscape.

Contract Management Consulting

In the complex world of healthcare, effective Contract Management is essential to maximizing revenue potential and ensuring compliance between payers and providers. Our Contract Management Consulting service, led by industry veteran A.J. Johnson, provides healthcare organizations with the expertise needed to navigate and optimize contract terms, reimbursement schedules, and compliance standards. Through meticulous analysis and strategic guidance, we help clients align contract terms with their financial goals, ensuring that they are capturing the full value of their payer agreements.

Our Approach: Step-by-Step Contract Management Consulting

Comprehensive Contract Review

We begin with an in-depth review of existing payer-provider contracts, focusing on critical elements such as reimbursement rates, fee schedules, and payer terms. This helps identify inconsistencies or ambiguities that might lead to revenue loss or non-compliance.

Root Cause Analysis (RCA)

Using RCA, we delve into recurring issues such as underpayments, delayed reimbursements, or contractual non-compliance. By identifying the underlying causes, we can address these issues systematically to reduce future contract-related disruptions.

Benchmarking and Comparative Analysis

We conduct a benchmarking analysis of contract terms against industry standards, ensuring that clients receive fair and competitive terms. This comparison allows us to highlight any potential areas for improvement and align contract terms with the best industry practices.

Revenue Optimization

After analyzing fee schedules, contract terms, and service codes, we propose adjustments to maximize reimbursement. This may involve renegotiating terms or revising fee schedules to capture full value from the services rendered.

Payer Compliance and Standardization

We implement standardized processes for managing contract terms, ensuring consistent adherence to payer guidelines and reducing the risk of non-compliance. By creating clear, enforceable terms, we simplify payer interactions and minimize administrative overhead.

Ongoing Monitoring and Adjustment

Our service extends beyond initial implementation. We set up regular monitoring and reporting systems to track contract performance, identify trends, and adjust strategies as needed, ensuring long-term financial stability and operational success.

Our Contract Management Consulting service has yielded significant results, including millions in recovered underpayments and stronger, clearer network agreements for our clients. By combining RCA, benchmarking, and revenue optimization, we empower healthcare providers to achieve greater transparency, control, and profitability in their payer contracts.