Revenue Cycle Services

Insurance ELigibility

When a patient has active insurance coverage, it means that the individual has a current and valid insurance policy in place that provides them with financial protection and benefits for healthcare-related expenses. This active coverage allows the patient to access medical services and treatments while having the associated costs partially or fully covered by their insurance provider, subject to the terms and conditions of the policy.

Authorizations

Authorization refers to the approval or permission granted by a patient's insurance company or healthcare provider for specific medical services or procedures. It is typically required for certain treatments, diagnostic tests, surgeries, or hospital admissions, especially when they are considered non-routine or elective. The purpose of authorization is to ensure that the requested medical service is medically necessary, appropriate, and covered by the patient's insurance plan.

Refferals

A referral is a recommendation made by a primary care physician (PCP) or general healthcare provider to a specialist or another healthcare professional for a specific medical condition or treatment. It often serves as a formal request to consult with or receive care from a specialist or subspecialist who has expertise in a particular area. Referrals are commonly required by health maintenance organizations (HMOs) and certain insurance plans as a means of coordinating and managing a patient's hea

Submission of Claims

Claims processing is a complex and crucial component of the healthcare and insurance systems, as it ensures that patients receive the appropriate benefits and healthcare providers are compensated for their services. Accurate and efficient claims processing helps streamline the reimbursement process, reduce errors, and improve overall patient and provider satisfaction.

Payment Posting

payments are received from patients or insurance companies, they are posted to the respective accounts. This process involves recording the payment amounts and reconciling them with the outstanding balances.

ACCOUNTS RECEIVABLE

Medical accounts receivable are the unpaid claims or bills for healthcare services, treatments, and procedures that have been provided by healthcare providers, such as hospitals, physicians, clinics, and other medical facilities.

Revenue Analytics

Revenue analytics is the process of collecting, analyzing, and interpreting financial data and metrics associated with an organization's income and revenue streams. It involves using data-driven techniques and tools to gain insights into the various factors that influence an organization's financial performance, revenue growth, and profitability. Revenue analytics aims to help businesses make informed decisions, identify opportunities for revenue enhancement, and optimize their overall revenue.