“Keeping up with the billing regulations and enrollment standards for all 50 states was unmanageable for our out of state Medicaid patients. FIRM RCM simplified this process for us and manages the entire process from payer notification and authorization to billing and follow-up.” OOS client testimonial
FIRM RCM provides a cost effective solution for what is most hospitals most labor intensive and lowest reimbursement financial class. FIRM RCM is one of the largest providers of out of state Medicaid billing and enrollment services (OOS) in the country and provides hospitals with skilled staff to provide research, provider enrollment, treatment authorization (TAR’s), billing, follow-up, and appeal service, on any foreign State Medicaid account assigned.
FIRM RCM offers a reasonable cost, contingency based solution that is both turnkey and has minimal impact on your staff resources. Once we can source the documents for your facility that are required by all states for foreign state enrollment, we can be relatively self-sufficient for the rest of the application process.
We will maintain and manage your out of state enrollments to keep your Hospital’s status “active” in each states program to the greatest extent possible. We will complete all foreign state enrollment applications, complete with required documentation, for the appropriate person at the hospital to sign. We will then file and track the completed application with each state so that claims can be submitted.
FIRM RCM will also work with your registration and admitting staff to make all payer notifications and to acquire valid authorizations for all of your IP and observation patient admits. This will free your staff from time consuming phone tag with payers to meet timely notification requirements.
We bill claims for all 50 states with the state specific codes and modifiers according to each states submission criteria. Once a claim has been submitted for payment, it is followed closely for payment. All payments are reviewed for compliance with applicable contracts or state fee schedules and denials and underpayments are appealed for additional reimbursement.