DRCHRONO REVENUE CYCLE MANAGEMENT SCOPE OF SERVICES GRID

Last updated: Oct 5, 2022

This document is intended to help DrChrono Customers understand the workflows required of Customer’s to enable DrChrono to perform Revenue Cycle Management (RCM) Services. This document is not an exhaustive listing of all Customer responsibilities with respect to the RCM Services. For a full understanding of all Customer obligations, please refer to your RCM Services Agreement with DrChrono.

Table 1 lists Standard RCM Functions within DrChrono’s standard RCM workflow and delineates all Actions, Customer Responsibilities, and DrChrono Responsibilities related to that Standard Function. Table 2 lists Alternative RCM Functions that are offered by DrChrono to Customers, in some cases at an additional fee. If a Customer requests any Alternative Functions, the Actions, Customer Responsibilities, and DrChrono Responsibilities listed in Table 2 will supersede the corresponding Actions, Customer Responsibilities, and DrChrono Responsibilities related to that specific RCM Function listed in Table 1. Any Standard RCM Functions that may be replaced at Customer’s direction are marked in Table 1 with an *.

Table 1 – Standard RCM Functions and Associated Actions, Customer Responsibilities and DrChrono Responsibilities
Standard RCM Functions	Actions	Responsibility
		Customer	DrChrono
Authorization*	Customer will work with the insurance to obtain the authorization. The Customer will enter in the necessary authorization details in the Authorization sections of the patient’s chart
Benefit Verification*	Customer will work with the insurance to get the patient’s benefit details. Customer will then change the billing status to “Eligibility Confirmed.”
Medical Coding*	Customer will code the claims with the necessary CPT/HCPCS codes, diagnosis code, modifier, and units and set the billing status to “Ready to Bill.”
Claims Submission*	The DrChrono Billing Representatives is responsible to work on the claims in the billing status, “Ready to Bill”. The billers will scrub the claims and submit them to the insurances.
Rejections (Clearing house & Payer)	The DrChrono Billing Representatives are responsible for working on the rejected claims and will review the rejections and resubmit the claims to the insurances.
ERA Posting*	Electronic Remittance Advice (“ERAs)” will be posted automatically in DrChrono when received from the payer/clearing house.
Unmatched ERAs	For appointments created in the DrChrono software, the DrChrono Billing Representatives is responsible to work on all unmatched ERAs and post the payments
	Customer is responsible to work on all unmatched ERAs and post the payments for any unmatched ERAs billed out of any non-DrChrono software.
Manual Payment Posting (paper EOBs)	Customer must scan and upload the paper Explanation of Benefits (“EOBs”) to the DrChrono software.
	The DrChrono Billing Representatives will post the payments that are uploaded to the DrChrono software.
Denials*	Except for authorization and coding-related denials, the DrChrono Billing Representatives will work on the denials received via ERAs and uploaded EOBs. The DrChrono Billing Representatives will move coding-related denials and any other denials needing Customer review to the billing status “Pending Info Customer.”
	Customer is responsible to work on coding related denials and any claims that are in the billing status “Pending Info Customer”. Once the Customer has resolved such denials, the Customer must change the status of the claim to “Attention to Biller.”
	The DrChrono Billing Representatives will work on the claims in the billing status “Attention to Biller” and take necessary action to re-submit claims.
Appeals	The DrChrono Billing Representatives are responsible for sending appeals to the insurances.
Claims follow-up with payer	The DrChrono Billing Representatives will follow up with the insurances on the outstanding claims.
Patient Statements	The DrChrono Billing Representatives will send patient statements on a monthly basis.
Patient follow-up	The DrChrono Patient Support Representatives will follow-up with the patients on their outstanding balances after sending 3 statements and if there is no response from the patients.
Patient support	The DrChrono Patient Support Representatives will be responsible for answering patient phone calls related to billing. A dedicated phone number will be provided to the patients on their statements so they can reach the DrChrono Patient Support Representatives, and their working hours is from 8 am to 8 pm Eastern Time Monday to Friday.
EFT enrollments*	EFT enrollments are a Customer responsibility.
Demographics update with insurances*	Updating Customer demographics with insurances are a Customer Responsibility.
Payer rate negotiations	Contracting reimbursement rates with payers is a Customer Responsibility.
Cash Services	Cash Services are a Customer Responsibility.

Table 2 – Alternative RCM Functions and Associated Actions, Customer Responsibilities and DrChrono Responsibilities
Alternative RCM Functions	Actions	Responsibility
		Customer	DrChrono
Authorization	Customer to set the billing status to “Authorization Needed” so the DrChrono Billing Representatives can contact the insurance.
	For appointments set to the “Authorization Needed” billing status by Customer, the DrChrono Billing Representatives will work with the insurance to obtain the authorization. The DrChrono Billing Representatives will change the billing status either to “Authorization Requested” or “Authorization Approved” or “Authorization Denied” depending on the response from insurance.
Benefit Verification	Customer to set the billing status to “Eligibility Needed” so the DrChrono Billing Representatives can contact the insurance.
	For appointments set to the “Eligibility Needed” status by Customer, the DrChrono Billing Representatives will work with the insurance to get the patient’s benefit details, and DrChrono Billing Representatives will then change the billing status to “Eligibility Confirmed”.
Medical Coding	Customer will lock the clinical note and set the billing status to “Ready to Code”.
	For claims set to the “Ready to Code” billing status by Customer, DrChrono’s Coding Representatives will review the clinical notes and code the claims. If clarification is required from the Customer in order to code the claims, the DrChrono Coding Representatives will change the billing status to “Coding Clarification” with any applicable comments in billing notes.
	The Customer will need to review the claims that are marked with the “Coding Clarification” billing status, provide clarification or responses, and then change the billing status to “Coding Clarified”.
	For claims set to the “Coding Clarified” status by Customer, DrChrono’s Coding Representatives will review the details provided by Customer, ensure the clarification provided by Practice was satisfactory, and code the claim.
Claim Submission (Function Provided to Medical Coding Customers)	The DrChrono Coding Representatives will change the status to “Ready to Bill” and submit the claims to the insurances.
ERA Posting (Customer Opts-Out of Auto Post)	If the Customer has enabled the option not to auto post the ERAs and unless Customer provided DrChrono with a daily deposit log of their bank, the Customer must manually verify the ERAs in the remittance reports screen.
Denials (Service Provided to Medical Coding Customers)	The DrChrono Billing Representatives will work on the denials received via ERAs and uploaded EOBs and any coding-related denials. The DrChrono Billing Representatives will move any denials needing Customer review to the billing status “Coding Clarification.”
	The Customer will need to review the claims that are marked with the “Coding Clarification” billing status, provide clarification or responses, and then change the billing status to “Coding Clarified”.
	For claims set to the “Coding Clarified” status by Customer, DrChrono’s Coding Representatives will review the details provided by Customer, ensure the clarification provided by Practice was satisfactory, and re-code the claim.
EFT enrollments	EFT enrollments are a DrChrono responsibility
Demographics update with insurances	Updating Customer demographics with insurances are a DrChrono Responsibility
Cash Services	Monthly Collections Rate in the applicable RCM Services Agreement between DrChrono and Customer will apply to any cash collections performed by DrChrono.