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Veridical RCM: Clean Claims with a Personal Touch
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Melissa A. Hanley, CEO, Veridical RCM It was a late Friday evening when the phone rang. Although Melissa Hanley, the CEO of Veridical RCM, had just settled down to relax after a hectic workweek, she immediately answered the phone when she saw who was calling. The healthcare provider on the line was a long-standing client of Melissa’s, and she had always prided herself on her philosophy of absolute responsiveness as one of the core tenets of her organization. The sense of urgency in the caller’s voice was soon assuaged by Melissa’s reassurance that her team would handle the matter, which pertained to a patient’s questions about their explanation of benefits. The Veridical team understands that the revenue cycle is complex, especially in some of the niche sectors that they specialize in, and many providers and practices don’t have the time to focus on all the nuances and intricacies involved.
The relationship with this provider began with a special project resulting from an audit that Veridical was asked to perform. The scope of the project resulting from this audit essentially directed the team to reassess and recapture the AR from one payer that the practice had written off more than a year prior. The Veridical team was so successful with this project that the entire practice decided to fully outsource all billings and collections to Melissa’s team. The evolution of this relationship is essentially the mold that the company has been built upon. “Our approach of availability, transparency and clear communication never ceases to surprise our clients,” says Melissa. Veridical RCM has supported numerous healthcare providers since its inception and is uniquely positioned to navigate its clients through the labyrinth of revenue cycle management. In 2014, when Melissa cofounded Veridical RCM, she could see a need for her more personal approach to this discipline. As a highly accomplished, results-driven, healthcare executive with more than twenty-five years of progressive leadership experience in finance and operations, Melissa today leads her dynamic team at Veridical RCM to create a powerful impact on a crucial piece of revenue for various healthcare organizations: compliant insurance reimbursements.
At its core as a revenue cycle management company, Veridical RCM is frequently focused on niche healthcare verticals, such as intraoperative neurophysiological monitoring, interventional radiology, and anesthesia, although it also has clients in the less niche healthcare space, and has worked with several more conventional groups along the way. Partnerships are tailored to the needs to the client and include services such as helping with billing compliance, optimizing revenue capture, accounts receivable audits, and hospital contract negotiations. The company brings three decades of rich experience in operational and revenue arenas for these specialties, and also has team members with clinical backgrounds to aid in this process.
Our approach of availability, transparency and clear communication never ceases to surprise our clients
Melissa brings the operational rigor learned through years in the U.S. Navy to drive efficiencies and reproducibility to the rest of her team.
To begin with, the Veridical RCM team generally provides a quick analysis to look for any revenue gaps that may exist as well as confirming that invoicing is being done correctly and being paid according to the terms of the existing contracts. The team can also assist clients in the contract negotiating process if required.
Instead of just managing the claims for the clients, Veridical RCM provides a very personal touch with the services by attaining an in-depth understanding of their business. They focus on the clinical, operational and revenue cycle aspects and help them overcome their pain-points. “Understanding the payer policies, clinical documentation and learning the nuances of the revenue cycle for niche disciplines helps us to stay hyper-focused on any changes and trends before then have impact on our partners’ revenue. This approach often makes us unique in the industry,” says Melissa.
She emphasizes that for certain complex or lesser understood healthcare services, the revenue cycle is comprised of many elements, and all of them must function seamlessly and concurrently in order to yield a healthy bottom line. That said, the RCM services offered by Veridical go beyond just billing and collections. While one of the most frustrating aspects of this business is performing a service and not getting paid, the team ensures that credentialing and clinical documentation is done correctly. In doing so, all the patient information received is verified, and the eligibility is checked to make sure that they are covered for the services and tests offered by clinical groups. The company also explores everything from reporting to fee scheduling to help organizations and payers stay on the same page. “Many things, if documented differently, could make all the difference of getting a claim paid or not. This is where Veridical steps in to walk them through the documentation—for both the business and clinical sides of the service. This certainly provides them with a pristine chart wherein they don’t have to go back and forth, waiting for more records,” explains Melissa, before adding that organizations must have the necessary processes in place to support the highest collections per case.
To enable that, the Veridical RCM team reviews the client’s existing RCM infrastructure and makes suggestions critical to their success through its hospital and payer contracting services. In a nutshell, Melissa informs that appropriate data, demographics, and pre-authorizations are collected from the front office, along with the front-end infrastructure and appropriate resources, as this is imperative to maximize the chances of payment.
Veridical RCM is also uniquely positioned to help providers obtain the highest reimbursements on out-of-network bills by employing its rich expertise, should they happen to not participate in various plans. Melissa underscores that to get an out-of-network claim paid is a challenge in and of itself. The complexities pertaining to diagnosis and procedural codes and a diverse payer mix (especially during the COVID-19 pandemic) play an instrumental role in achieving a clean claim, good patient care, and a medicolegal safeguard.
The key is to do it the right way every single time from the start. “We have a robust appeals process that gets turned around as fast as possible,” adds Melissa.
With an aim to help clinical practices increase their collections, Veridical RCM ensures that clients have compliant billing and collections processes. Doing so boosts their confidence when responding to an audit. To tackle the compliance issues that arise in the job, Veridical RCM is equipped with professionals like Certified Compliance Officers and Certified Medical Auditors to help their clients’ breeze through the documentation process that seems daunting. “We may not always bill at the highest rate, but we will certainly help you to keep the money you collect,” Melissa quips. She adds that there were several instances when one of their clients came to them with nearly three-years worth of claims. After they diligently went through the documents, they were well-versed with payer policies and coding and were able to fight for their clients. In doing all of this, Veridical is very much aligned with the philosophy of revenue integrity.
Moving forward, Veridical RCM seems unfazed by the pandemic and looks forward to expanding its footprint. “We have grown quickly and organically over the lifespan of Veridical solely via word of mouth,” says Melissa, adding, “We don’t aim to be the biggest group out there, but we will continue to expand intelligently by partnering with like-minded groups who want to do things the right way, thereby allowing them to focus their attention to patient-care.”
Description Veridical RCM is a full-service revenue cycle management company specialized in complex or less understood areas of healthcare.Partnerships are tailored to the needs to the client and include services such as helping with billing compliance, optimizing revenue capture, accounts receivable audits, and hospital contract negotiations. The company brings three decades of rich experience in operational and revenue arenas for these specialties, and also has team members with clinical backgrounds to aid in this process. Veridical RCM is also uniquely positioned to help providers obtain the highest reimbursements on out-of-network bills by employing its rich expertise, should they happen to not participate in various plans
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