Our Services

Home Our Services
Services 1 - Revenue Cycle Management

1. REVENUE CYCLE MANAGEMENT

The healthcare revenue cycle is a complex maze of all administrative and clinical processes that are required to capture, manage, and collect the money for medical services rendered to patients.

a. Front End Revenue
⇒ Patient scheduling and appointment
⇒ Eligibility & Benefits Verification
⇒ Prior authorization
⇒ Patient Demographics/Registration

b. Mid Revenue
⇒ Chart audit & Charge entry
⇒ Medical coding & audit
⇒ Documentation improvement
⇒ Scrubbing

c. Back End Services
⇒ Processing Remits & Paper EOBs
⇒ Account receivables
⇒ Denial Management
⇒ Credit balance
⇒ Patient invoices
⇒ Patient relations

2. AUDITING

At MedCaliber, we offer a full comprehensive Auditing services to help practice optimize their revenue. We identify strength and weaknesses of your coding, documentation, billing and reimbursement and report opportunities for improvement.

⇒ Internal Audit
⇒ MS-DRG Validation audit
⇒ APC Audit
⇒ Audit services for facilities
⇒ Audit Services for Physicians
⇒ Audit services for clinics
⇒ Audit services for Laboratory & Radiology centers

Untitled design (2)

3. CREDENTIALING

Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.  Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in their practice – failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to. However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request. Trust Access Healthcare to get you credentialed fasters as we understand the forms required by each payer, and their policies and procedures.

a. Application Evaluation. Completing required documentation and identifying exceptions.
b. Primary Source Documentation. Verify practitioner/ facility information from physicians.
c. Outbound Call Center. Obtain missing documents and updating the payer’s database.
d. Follow-up with payers. Follow-up on submitted credentialing requests.
e. Data Entry. Capture data, label, and link images to specific providers/ facilities in the payer’s database.
f. Maintenance of Provider Data. Update provider information as per policies and procedures, and CAHQ profile.

4. ENROLLMENTS

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:
a. Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims
b. Updating practice’s Pay-to address. Validate and update the provider’s pay-to address or the billing address
c. Enrolling in electronic transactions. Our team can enroll providers for        → four types of electronic transactions:
→ Electronic Data Interchange (EDI)
→ Electronic Remittance Advice (ERA)
→ Electronic Fund Transfer (EFT) and
→ CSI
d. Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

5. HL7 INTEGRATION

Real-world integration takes place between multiple applications in multiple locations. Healthcare interface traffic can be intense so a strong traffic director in the middle is extremely important. Else, the output will get delayed which might lead to costly implementations, application modifications, etc. Each application in the integration path should be able to send and/or receive data, ideally in an HL7 format.

a. Export endpoint – sending application
b. Import endpoint – receiving application
c. Methodology – move data between two endpoints
d. Methodology – handling the queuing messages
e. Methodology – sorting the message flow

6. DATA MIGRATION

Medical practices can spend months researching, selecting, and implementing a new EMR. Each practice has unique requirements and should choose an EMR that satisfies their needs. Once a new EMR is selected, the challenge becomes how to import legacy data into the new EMR or how to keep legacy data accessible without burdening the new EMR. MedCaliber provides data migration as well as data extraction services, we have been successfully extract data out of multiple EMR software like ECW, Lytec, All Scripts, Medinotes etc.

We can as well insert data into software like Intelligent Medical Services, apart from that the we also hail expertise in database management. Our team of database developers can create any custom report as per your need.

MedCaliber’s experienced resources makes this data migration process smooth, we analyze your existing data as well as the new database and share the report with the you and explain you of what should be converted and what should be included. Once completed we initiate a test conversion and if the data is verified by the client we do the live conversion. We also support multiple incremental conversions.