BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Credit Balance Adjudication
Get hassle-free credit balance refunds with our expert services
Our team of professionals will ensure that your refund process is compliant with regulations and streamlined for maximum efficiency. Trust us to maintain your financial integrity while saving you time and headaches
Schedule a Call2.5 hours
Average Adjudication Turnaround Time
87%
Approval Rate for Credit Balance Adjustments
1.2%
Error Rate in Adjudicated Credit Balances
Overview
Credit Balance Adjudication: A Pillar of Financial Integrity at ASP-RCM Solutions
At ASP-RCM Solutions, we understand that managing credit balances is not just a matter of financial housekeeping—it’s about maintaining trust, adhering to regulations, and ensuring the financial health of your practice
Identify and investigate
ASP-RCM Solutions routinely scans accounts to discover and evaluate these balances. Whether the problem is caused by payer inconsistencies, patient overpayments, or system faults, we treat it with the attention it deserves.
Contact the payer
We engage directly with insurers to ensure payment accuracy and determine whether refunds, reprocessing, or other actions are required. This guarantees that all parties are in agreement and that the settlement process moves forward without unnecessary delays
Issue refunds
We ensure refunds to patients, payers, or other parties are processed promptly and in full compliance with provided instructions, fostering trust and adherence to payer and patient guidelines
Maintain diligent documentation
ASP-RCM Solutions maintains detailed records of all credit balance transactions, including investigations, communications, and reimbursements. This ensures a clear, auditable trail that provides peace of mind and ensures regulatory compliance
Conduct periodic audits
We conduct regular audits of the credit balance management process to ensure quality, compliance, and alignment with regulatory standards, while identifying areas for improvement and adhering to best practices
Operations
Posting Credit Balance: A Critical Component of Revenue Cycle Management
At ASP-RCM Solutions, our systematic approach to posting credit balances ensures that every aspect of the process is handled with diligence, accuracy, and transparency
Confirm the Balance
Before taking any action, we verify the existence of a credit balance to ensure accuracy. Verifying balances ensures that subsequent actions are grounded in factual data
Review the Source
Once a credit balance is confirmed, we examine its source to determine why it exists. This could stem from patient overpayments, payer adjustments, or billing corrections. By thoroughly understanding the origin, we ensure that the credit is legitimate and appropriately resolved
Maintain Detailed Documentation
Proper documentation is a cornerstone of our credit balance management process. For every credit balance, we maintain detailed logs that include the source, reason, and actions taken to resolve the issue
Notify the Patient
In cases where the credit balance is due to a patient overpayment, we proactively inform the patient and offer resolution options. Clear communication is critical to maintaining trust and satisfaction
Process Refunds
If a refund is applicable, we follow established protocols to issue the refund promptly. By acting quickly and accurately, we minimize delays and maintain positive relationships with patients and payers
Offset Charges
Denials are managed with precision using Waystars advanced analytics. We identify trends, address systemic issues, and create targeted strategies for specific denial categories. By monitoring outcomes and refining processes, we optimize denial management and improve financial performance
Adjust Future Claims
In some cases, credit balances may be applied to future claims as adjustments. Our team carefully tracks and applies these adjustments to ensure compliance and maintain financial accuracy
Periodic Reconciliation
Periodic reconciliation is essential to maintain financial clarity and prevent discrepancies. We regularly reconcile credit balances to ensure that all accounts are accurate and up to date
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
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