💰 Revenue Cycle Management (RCM)

Complete end-to-end revenue cycle management that optimizes cash flow and reduces administrative burden:

• Patient Registration & Insurance Verification: Accurate data collection and real-time insurance eligibility verification
• Pre-Authorization Management: Fast pre-auth processing with daily follow-ups ensuring timely approvals
• Charge Capture & Billing: Comprehensive charge capture ensuring no revenue leakage
• Claim Submission: Timely, accurate claim submission with complete documentation
• Payment Posting & Reconciliation: Daily payment tracking and accurate reconciliation
• Accounts Receivable Management: Systematic follow-up on pending claims until payment
• Patient Collection Support: Professional handling of patient payment obligations
• RCM Analytics & Reporting: Detailed performance metrics and improvement recommendations

Typical Results: 60% reduction in claim denials, 40% faster payment collection, 95%+ revenue recovery rate

📋 Medical Coding Services

Expert coding services ensuring accuracy and compliance:

• ICD-10 Diagnostic Coding: Accurate diagnosis coding by certified professionals
• CPT Procedure Coding: Precise procedure coding for all medical services
• Coding Quality Audits: Regular audits to ensure coding accuracy and compliance
• Documentation Improvement: Training and guidance to improve clinical documentation
• Specialty-Specific Coding: Expertise across multiple medical specialties
• Coding Compliance: Stay updated with latest coding guidelines and regulations

❌ Claims Denial Management

Systematic approach to minimize denials and maximize revenue recovery:

• Denial Analysis: Root cause analysis of every denied claim
• Appeal Preparation: Professional appeal letters with supporting documentation
• Denial Prevention: Identify patterns and implement preventive measures
• Recovery Management: Systematic follow-up until claim resolution
• Reporting & Analytics: Track denial rates, reasons, and recovery performance

🔍 Medical Claim Audits

Comprehensive auditing ensuring compliance and fraud detection:

• Pre-Authorization Audits: Verify medical necessity and policy coverage before treatment
• Post-Payment Audits: Identify overpayments, billing errors, and recovery opportunities
• Fraud Detection: Advanced algorithms and expert analysis to flag suspicious patterns
• Compliance Verification: Ensure adherence to IRDAI guidelines and regulations
• Clinical Documentation Review: Assess completeness and accuracy of medical records
• Coding Accuracy Audits: Verify proper application of ICD-10 and CPT codes

✅ Pre-Authorization Support

Fast, efficient pre-authorization processing:

• Same-Day Submission: Submit pre-auth requests within hours of admission
• Complete Documentation: Ensure all required documents are included
• Daily Follow-ups: Persistent follow-up until approval received
• Enhancement Requests: Professional handling of additional amount requests
• Status Tracking: Real-time tracking and reporting of all pre-auth requests

📊 Healthcare Analytics

Transform data into actionable insights:

• Predictive Analytics: Forecast claim patterns, denial trends, and revenue projections
• Performance Dashboards: Real-time visualization of key metrics and KPIs
• Cost Analysis: Identify cost-saving opportunities and optimize resource allocation
• Denial Analytics: Analyze denial patterns and identify root causes
• Payer Performance Analysis: Track TPA and insurance company performance
• Custom Reports: Tailored analytics for your specific needs

⚖️ Compliance Consulting

Stay compliant with evolving healthcare regulations:

• IRDAI Compliance: Ensure adherence to insurance regulatory guidelines
• Ayushman Bharat Compliance: Help with PMJAY scheme compliance
• Documentation Audits: Review and improve clinical documentation practices
• Policy Compliance: Verify adherence to internal policies and procedures
• Training & Education: Staff training on compliance requirements