Revenue Cycle management

We create custom revenue

cycle management solutions

Revenue cycle management (RCM) is a financial process used by healthcare providers to track patient records, manage claims processes, generate revenue, and manage reimbursements.

Complete
Revenue
Cycle
Management
Solutions

Our clients enjoy custom strategies that are tailored to the unique revenue flow challenges of each practice or lab. Plus, we’re so committed to helping our clients save money that we always offer the option to work with a client’s existing software! Our dedicated team is ready to help you create a revenue growth action plan with automated, optimized processes.

We Offer End-To-End RCM Solutions

We provide the world class best services to Client, process of submitting and keeping tracks of claims with health insurance companies to receive payment for services rendered.

1) Network Participation Management

We provide consulting for self-credentialing or full-service credentialing services to guide your agency through the process of becoming an in-network participating provider with national and state health insurance funders.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

  • Process address and demographic changes for contracts or individual providers.

  • Ongoing follow-up with health insurance funders through completion of executed contract and credentialing effective date.

  • Provide periodic status updates for ongoing work in progress.

2) Insurance eligibility & benefit verification
(Which includes Authorization management)


Pre-appointment patient engagement

Our commitment to value-driven care makes for a hassle-free experience right from pre-registration. Key information such as insurance coverage, payer limits and co-pay options are analyzed before the patient arrives for the visit.

We navigate insurance eligibility to verify benefits and submit authorization requests to health insurance funders, professionally interfacing with insurance coordinators and providing support and consultation to your agency.

Ineffective eligibility and benefits verification and/or prior authorization processes can result in increased claim denials, delayed payments, additional effort on rework, and delays in patient access to care, decreased patient satisfaction, and non-payment of claims.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

3) Demographics entry


Complete and accurate capture to optimize clean claim

Error-free patient demographic entry is required to facilitate quick processing of the insurance claims by the insurance company.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

4) Coding

The first step towards clean collections

Our commitment is to streamline our customer’s coding tasks to grant them and their patient’s peace of mind.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

5) Charge capture

Analytical diligence on all billable charges

Before the claims are transmitted to the carriers, we run them through multiple checks to ensure 100% accuracy.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

6) EDI ERA EFT setup

Hassel free quick payment

Our electronic optimization processes help you receive payer responses quicker. You’ll save time, get paid faster from insurance companies, and avoid disruptions to your cash flow.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

7) Claims submission

Consistently clean claims are part of our culture

As part of our quality assurance process, we submit all claims to an internal Clearing House. This extra step ensures that all claims are as clean as possible and that you get paid the first time.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

8) Remittance


Matching remittance advice with account receivable

We screen the remittance advices at every item level and match them with the respective billing guidelines. This approach helps spot the underpaid and initiate action to get paid with additional reimbursement.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

9) Account receivable management

Initiate appropriate action on unpaid claims

The collections process requires a careful eye. We keeps you informed in advance of all past-due collections and will help you realize any lost revenue.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

10) Denial management

Minimize denials and increase the circumstances of getting paid faster

We uses a systematic, hands-on approach to ensure that appropriate action is taken for each denied claim, adhering to a strict systematic quality-control. This guarantees optimal results and streamlined collections.

  • Resolve claims with speed.

  • Automated workflow with blended solution of technology and service.

  • Prevent future denials applying strategy to frontend process.

SOLUTIONING

Your needs are unique. That’s why we take a solutioning approach centered first on understanding those needs and the specific results you seek to achieve, then applying The best practices model for achieving those results.

Revenue Cycle Best Practices Engine

Dial up the right fit and achieve an unprecedented level of control and visibility in managing your revenue cycle. Boost your financial success by implementing unique performance improvement solutions

ACHIEVE RESULTS

Much change is afoot in managing revenue cycle for hospitals, physician billing companies, and physician practices alike. Reap predictable results with improved process performance, quality, and turnaround time. Accelerate your goal achievement by… 

1) Reducing collection costs
2) Raising net collections
3) Reducing effort and error

Achieving a competitive advantage in a crowded RCM space requires far more than labor arbitrage offered by so many offshore partners. Leverage the MedHealth best practices engine across some or all of RCM disciplines…from scheduling to collections, to accelerate cash flow while freeing up resources so you can help your clients create better patient experiences while growing your own business. 

Benefits & Authorization
Management

We navigate insurance eligibility to verify benefits and submit authorization requests to health insurance funders, professionally interfacing with insurance coordinators and providing support and consultation to your agency.

Ineffective eligibility and benefits verification and/or prior authorization processes can result in increased claim denials, delayed payments, additional effort on rework, delays in patient access to care, decreased patient satisfaction, and non-payment of claims.



Our Services

MedHealth brings you a team of experts to help you accelerate your client’s accounts receivable cycle. We confirm the patient’s eligibility and obtain necessary prior authorization before the patient visits the physician’s office.

we do the below verification processes:

  • Receive patient schedule from the healthcare provider’s office – hospital and/or clinic

  • Perform entry of patient demographic information

  • Verify coverage of benefits with the patient’s primary and secondary payers

  • Coverage – whether the patient has valid coverage on the date of service

  • Benefit options – patient responsibility for copays, coinsurance, and deductibles

  • Where required, the team will initiate prior authorization requests and obtain approval for the treatment

  • Update the hospital’s revenue cycle system or the patient’s practice management system with the details obtained from the payers

Benefits

MedHealth eligibility and benefits verification and prior authorization services offer :

Save over 50% in operational costs 
  • In-house verification can be costly. Our team members based in India pick up the work queues and process each request diligently.

Improve speed to care delivery
  • Efficient prior authorization processing means that the patient can be scheduled for care reviews with the physicians timely, thereby improving patient satisfaction as well as physician utilization.

Reduce Claim Denials. 
  • Reduction in eligibility verification and Prior authorization related denials ensures that there is a lesser number of claim denials and cash flow is accelerated.

Reduce Bad Debt, Increase Cash Collection
  • Upfront determination of Patient responsibility for payments reduces patient debts and improves POS collections, besides improving Patient Satisfaction

Focus on growing your business
  • we take over the entire process at less than a third of the costs, you can now refocus your employees on growing your business.

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