Medicare Claim Management and Revenue Cycle Management Service

The hospital seeks a vendor to provide comprehensive Medicare claim management and revenue cycle management services aimed at enhancing and maximizing third-party revenue and collection activities. The chosen provider will be responsible for implementing technology solutions that identify third-party eligibility, facilitate workflow management, and generate Medicare accounts receivable reporting. Real-time verification of eligibility for multiple health insurance programs is a key requirement to support efficient healthcare business operations.

The service should support both Medicare and private insurance claims, helping to optimize reimbursement capture from the point of service. Core functionalities include batch eligibility checks for multiple patients, workflow management through customizable dashboards, automated reminders and task assignments for staff across locations, and efficient processing of repetitive tasks. The proposed technology must allow batch imports of eligibility data, provide access to transaction history, and facilitate the electronic transmission of third-party and VA insurance claims through a secure platform.