Custom Revenue Cycle Management (RCM) software development and implementation. We program features for verifying insurance eligibility (with options for batching), accessing prior authorization and referrals, processing claims, locating clinical information from integrated healthcare systems, automating remittance advice, coordinating benefits, managing and appealing denials, and generating financial reports.
We integrate RCMs into standalone or multi-site Hospital Information Systems (HIS). We design payer contract management modules integrated with hospital-focused contract modeling functions, and program coverage detection software identify assistance opportunities for uninsured patients. We also offer reporting modules for analyzing enterprise-wide or department-specific KPIs.
We facilitate and track in real time insurance eligibility and claims submissions to primary, secondary, and tertiary payers, as well as Medicare and Medicaid, via provider-facing Service Oriented Architecture (SOA). We program claim scrubbing software for detecting errors in UB-04 and CMS1500 submissions and develop rules engines for ensuring compliance with carrier guidelines and federal regulations.
Designing of intuitive interfaces for accurately recording patient demographics, insurance information, and medical histories, with photo capture capabilities for paper submissions and customization controls for specialty practices. Integration with Electronic Medical and Health Records (EMR/EHR), Practice Management Systems (PMS), and master patient indexes for streamlining recurring patient check-ins.
Custom implementation of 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. Implementation of insurance verification software from third-party clearinghouses (ezVerify, RelayClearance, Availity, Emdeon.)
We integrate RCM software 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). We also offer ICD-9 to ICD-10 updates.
Development of medical billing systems with point-of-care payment processing for copays, deductibles, and coinsurance. We facilitate account reconciliation with patients via online payment portals. We also automate follow-up requests for delayed or underpaid reimbursements and program audit tracking software that archives every patient and insurer transaction in an easily manageable database. We integrate third-party medical bill payments solutions from SwervePay and MedBillit, among others.
Custom Business Intelligence (BI) programming for analyzing mission-critical data from clinical information repositories, Practice Management Systems, and Hospital Information Systems. Our custom RCM reports use intuitive data visualizations for conveying missed revenue opportunities due to coding errors, deficient patient data captures, poor patient relationship management, and technology failures.
Chetu's healthcare software development experts ensures your software complies with regulatory standards including specifications set by the U.S. Department of Health and Human Services (HHS), Office of the National Coordinator – Authorized Testing and Certification Body (ONC-ATCB), HITECH's Meaningful Use Stage 1 and 2 (MU-1 & MU-2), Health Insurance Portability and Accountability Act (HIPAA), and Health Level 7 International (HL7).