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How Regent RCM Leverages TRICARE Expertise to Maximize Reimbursement

Regent RCM has developed a high level of TRICARE expertise, another core competency that sets Regent RCM apart from other revenue cycle management (RCM) providers. This unique experience offers ambulatory surgery centers (ASCs) valuable knowledge to maximize their reimbursements.

TRICARE, the health care program for uniformed service members and dependents, is managed by the Defense Health Agency and covers nearly 9.5 million beneficiaries around the world. TRICARE serves active duty, retired and Guard/Reserve service members and their families, and benefits and plans vary widely depending on the beneficiary category and the region. Other insurance carriers also process claims for TRICARE, which adds to the complexity of billing and collecting payment for health care facilities.

“It’s a complex process to understand  – determining how to bill appropriately, how you should be getting paid, what they should reimburse you, and what’s included in reimbursement,” said Leslie Favela, revenue cycle supervisor at Regent RCM.

Favela explained that many ASC administrators are under the wrong impression that TRICARE won’t pay for certain procedures when billed, which makes centers reluctant to accept TRICARE patients in the first place. “This is an unfortunate misconception,” said Favela. “TRICARE offers set reimbursements for many procedures, but it is necessary to understand the intricacies of billing the claims correctly in order to maximize reimbursement.”

Regent RCM has conducted extensive research into TRICARE: How the billing process works, what to charge, and what procedures are allowed and not allowed. Importantly Favela notes, TRICARE rates change each year on November 1. “Regent RCM makes it a priority to maintain the most up-to-date reimbursement information as part of our team’s standard process,” explained Favela. “We pride ourselves on having an expert understanding of TRICARE expected reimbursement, which we then leverage to get the maximum payments for our ASC clients.”

TRICARE has an enormous reach, and Regent RCM’s proficiency in reimbursement is highly beneficial for centers located near military bases or serving uniformed patients and their families.