RCM & Medical Billing Software Solutions

Revenue Cycle Management Solutions

We offer customized Revenue Cycle Management (RCM) software solutions and implement them within the health systems. We program features for verifying insurance eligibility, processing claims, accessing prior authorization and referrals, locating clinical information from integrated healthcare systems, coordinating benefits, automating remittance advice, and generating financial reports.

RCM Eligibility Verification

We verify & track the real-time insurance eligibility and claims submissions to payers, as well as Medicare and Medicaid, via provider-facing Service Oriented Architecture (SOA). We design software for detecting errors in UB-04 and CMS1500 submissions and develop rules engines for ensuring compliance with carrier guidelines and federal regulations.

Hospital Revenue Cycle Management

We integrate RCMs into Hospital Information Systems (HIS), integrate contract management modules into hospital-focused contract modeling functions, and program coverage detection software identifies assistance opportunities for uninsured patients. We also integrate report modules for department-specific KPIs.

Third-Party RCM Implementation

Our well-versed developers are proficient in developing customized solutions by integrating third-party Revenue Cycle Management software (AllScripts, CureMD, NextGen), including cloud-based network development, HL7 interoperability management, and portal programming for interfacing with RCM financial managers. We implement insurance verification software by integrating with third-party clearing houses (ezVerify, RelayClearance, Availity, Emdeon.)

RCM Patient Management Software

We develop interfaces for accurately recording patient demographics, insurance information, medical histories, photo capture capabilities, etc. We integrate RCMs with Electronic Medical and Health Records (EMR/EHR), Practice Management Systems (PMS), and master patient indexes for streamlining recurring patient check-ins. 

Revenue Cycle Management Reporting

It includes programming custom Business Intelligence (BI) for analyzing mission-critical data from clinical information repositories, Practice Management Systems, and Hospital Information Systems. The RCM healthcare reports developed by us use cash flow intuitive data to inform missed revenue opportunities due to coding errors, poor patient relationship management, and technology failures. . 

Medical Coding/Billing Software Solutions

We develop RCM software to integrate with Practice Management Systems and EHR/EMR for pre-populating superbills with diagnoses and services rendered as well as proper International Classification of Diseases-10 (ICD-10) and Current Procedural Terminology (CPT) codes in accordance with the Center for Medicare and Medicaid Services (CMS).

Our developed medical billing systems facilitate payment processing for copays, deductibles, and coinsurance via online payment portals. Follow-up requests for delayed or underpaid reimbursements are also automated for increased patient engagement. We process integration of third-party medical bill payments solutions from SwervePay and MedBillit, etc.