Vendor Yearly Offerings

Scheduling Software and Services aim to improve the match between healthcare resources (doctors, nurses, rooms, equipment, medicines) and patient needs. Scheduling Software and Services reduce wait times for patients while also improving the utilization of critical resources.

Patient Access and customer service call center software and services for hospitals, health systems, and medical practices, drive patient engagement, improve patient satisfaction, and optimize revenue opportunities.

Patient Identification and Address Verification confirms patient identity, address, and demographic data against third-party sources to improve registration accuracy and the ability to communicate with your patients.

The process of verifying and auditing registration information, concurrently or retrospectively, detects registration errors that need corrections prior to billing to reduce rework and denials.

Eligibility and Benefit Verification Software and Services is the process of checking a patient’s active coverage with the insurance company and verifying the eligibility and benefits available to expedite payment of the patient’s insurance claims.

Patient Financial Counseling offers financial advice and assistance to patients regarding their medical bills. They are the liaison between patients and insurance companies, often coordinating payments and answering questions from both parties. Additionally, they collect payment from patients on behalf of the healthcare provider.

Prior and post-authorization is the process of getting an agreement from the payer to cover specific services before or after the service is performed. The Authorization process can be completed electronically or manually through a service offering.

An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give Medicare patients before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

A price estimate is the approximation of the charges, contracted cost of care and patient obligation. The price estimate is the product of the cost estimating process.

Patients may qualify for free or low-cost care through Medicaid based on income and family size. Medicaid eligibility solutions and services assist patients through the process of Medicaid eligibility.

HIPP is a Federal/State program currently in 37 states, where the state Medicaid agency pays the premium, coinsurance, and deductibles of eligible Medicaid patients to allow them to access private group commercial insurance or COBRA that is available to their family but unaffordable. This service assists patients in this process.

Presumptive Charity Eligibility is the process by which healthcare providers qualify patients for charity care as part of the benefit they provide to the surrounding community. Using technology that leverages credit-score-like data, estimated household size and income data, demographic information, and social media data, hospitals can determine whether patients are likely to qualify for charity care. Propensity to Pay automates the financial clearance of patients by condensing financial data into an easy-to-read format for quick decision-making during registration and financial counseling. This gives your organization a better idea of where patients stand financially and allows you to proceed accordingly.

Credentialing is the process of obtaining, verifying and assessing the qualifications of a healthcare practitioner to provide patient care services in or for a healthcare entity. To ensure consistency of credentialing, recredentialing, and privileging, a routine process should be followed.

Provider Enrollment is the process by which a medical provider gets entered into insurance plans, networks, Medicare and Medicaid so the provider can be paid for services rendered to patients.

Care Management Services, a team-based, patient-centered approach, is designed to assist patients and their support systems in managing medical conditions more effectively. Care Management software is used to manage and track patients within the healthcare and social services professions.

Itinerary-based scheduling is the concept of booking a well-coordinated set of appointments for clinical protocols and patient convenience.

Online bill pay is a quick and secure way to pay your hospital, doctor or other healthcare bills online.

Providing a seamless, consistent patient experience across any pre-service interaction. This includes delivering appointment reminders, estimates, and information requests plus the ability to provide personalized, affordable prepayment options and services that allow patients to confidently navigate the healthcare ecosystem.

Dictation/Speech recognition software is an alternative to typing on a keyboard. Put simply, you talk to the computer or other device and your words appear on the screen.

Release of Information (ROI) in healthcare is critical to the continuity of care provided to the patient. It also plays an important role in billing, reporting, and other functions. Many laws and regulations govern how, when, what, and to whom protected health information is released.

A transcription service is a solution which converts speech (either live or recorded) into a written or electronic text document. 

Domestic Medical Coding Services is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.

International Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.

A coding audit and accuracy tool is a comprehensive, customizable medical auditing solution, ideally with built-in workflow, audit management dashboards, detailed scorecards, and robust reporting. A coding audit and accuracy tool optimizes and accelerates the coding audit process. For hospitals and providers, it improves overall coding quality and compliance while providing the ability to access audited and scored records for education, review and process improvements.

Domestic medical audit services entail conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and compliant operation.

International medical audit services entail conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and compliant operation.

A computer-assisted coding system (CACS) is software that analyzes healthcare documents and produces appropriate medical codes for specific phrases and terms within the document.

By electronically analyzing all relevant patient notes with AI technologies such as deep learning and natural language understanding, Computer Assisted Physician Documentation technology automatically identifies clinical indicators in a patient’s record and advises physicians in real-time when there is important missing information that needs to be clarified

Clinical documentation software and services are at the core of every patient encounter. In order to be meaningful, it must be accurate, timely, and reflect the scope of services provided. Successful clinical documentation improvement (CDI) programs facilitate the accurate representation of a patient’s clinical status that translates into coded data.

Registry Management collection services make clinical data available for clinical trials, cancer registry, and registries for trauma, stroke, bone marrow, etc. Registry Management serves the organization on an interim, functional, or full-strategic basis.

Revenue and Charge Capture Integrity solutions utilize advanced data-mining and machine-learning algorithms (AI) to find trends and deep insights into your data. In addition to detecting missing charges, their predictive models can identify over- and under-payment variances.

The chargemaster, or charge description master (CDM), is a comprehensive listing of items billable to a patient or a patient’s health insurance provider. Ensuring appropriate charge levels and coding within the CDM is critical for payment accuracy and public perception.

Contract management includes negotiating the terms and conditions of insurance contracts and ensuring compliance with the terms and conditions, as well as documenting and agreeing on any changes or amendments that may arise during its implementation or execution. It can be summarized as the process of systematically and efficiently managing contract creation, execution, and analysis for the purpose of maximizing financial and operational performance and minimizing risk. Contract management may also include systems that net accounts receivables to expected payment.

A claim editing tool applies a rules-based engine to healthcare claims to help to ensure accuracy to receive payment promptly. Additionally, most claims editing companies provide clearinghouse services that send healthcare claims to insurers for payment.

HCC coding or Hierarchical Condition Category coding is crucial as it decides the reimbursement benefits for a Medicare Advantage Plan that uses ICD diagnostic codes as the primary indicators of the member’s health status. Since 2004, Medicare has used the HCC model to calculate payments to providers and health plans.

Utilization Management and Physician Advisory services to ensure appropriate patient status assignment and appropriate reimbursement for all payers.

A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced.

Credit Balances may be caused by true overpayments made by patients, commercial insurance companies, the government or simple accounting errors that result in a necessary corrective adjustment. There are governmental regulations as well as contractual obligations surrounding the timely resolution of Credit Balances.

Remittance data (either paper or 835 EDI transaction) is captured, accessible for searching, retrieving, downloading and more. Remittance data can also be manipulated into a viewable easy, consistent layout for all payers.

Reduce costs and save time with auto reconciling of bank funds – EFT and ERA matching

Merchant software refers to merchant processing services that enable a business to accept a transaction payment through a secure (encrypted) channel using the customer’s credit card or debit card or NFC/RFID enabled device

A system that eases the process of collecting on insurance accounts receivables.

A system that eases the process of collecting on self-pay or patient pay after insurance accounts receivables.

Insurance accounts receivable or A/R is a term used to denote money owed to a healthcare institution for services you have rendered and billed. Any payments due from payers, or other guarantors are considered A/R. A goal is to manage its A/R to ensure that it gets paid correctly in a timely manner.

Companies that provide comprehensive outsourcing of billing and collections for services provided to International patients.

Denial Management software is designed to drill into your 835 remittance data to uncover the root causes leading to denials. It analyzes, tracks, trends, and reports on denial data, identifying unpublished rules and recommending fixes for individual denied claims while helping you identify and implement process improvements to eliminate recurring denials and optimize revenue. Denial Management software can also provide a system in which to resolve denials.

Denial Management services provide outsourcing or account specialists to assist in resolving denials and collection services.

Complex Legal and Care Management Denial Accounts Receivable Services focus on claims that typically require legal or clinical intervention to finalize payment.

Patient refunds is the process of returning back any excess money paid by the patient. This could be on request by the patient or as a result of a resolved Credit Balance that results in a patient overpayment.

Recovery Audit Services is the systematic process of reviewing disbursement transactions and the related supporting data to identify and recover various forms of overpayments and under-deductions to payors. In other words, it’s the recovery of lost money.

Auto and Workers Compensation Collection Services provide expert and detailed accounts specialists to follow up on the unique requirements of these payers.

VA A/R services provide expert and detailed accounts specialists to follow up on the many types of Veteran related claims.

Each state has unique Medicaid rules and regulations. Out of State Medicaid services can assist in navigating the unique steps needed from registration to reimbursement.

Electronic Real-Time or Batch Claims Status Inquiry (CSI) allows you to electronically check the status of production claims after they have passed the front-end edits and received Claim Control Numbers (CCN). Through CSI, you will know if your claim has been paid, denied, or pending. It may also provide specific items on the payer’s website regarding your claim.

An early-out self-pay program focuses mainly on reaching out to those patients that have patient responsibilities in a customer service environment and assisting with payment arrangements, charity care, patient statements and establishing a good working relationship prior to going to the collection agency stage.

Retroactive Insurance Verification is utilized to identify missing insurance for active Self Pay Account. Retroactive Insurance Verification solutions query several eligibility sources to identify found Medicaid, Medicare, and Commercial coverage.

Patient statement solutions and services aim to be precise and easy to understand with clear statements related to information about the practice, cost breakdown of the services offered, date of statement, date due, remaining balance, and approved methods of payment, enabling the patients to pay on time

Patient Pay Financing firms provide patient finance solutions to hospitals, physician practices, and ancillary service providers. Patient financing helps patients pay their medical bills. A patient pay financing company is not a collection agency or credit card company.

Management of all self-pay accounts in which a patient has passed, including proactive identification of patients passing outside of facility, estate location, claim presentation, payment from probated estates, non-probated estates and trusts, with attention to survivor experience and specialized compliance controls. All estate searches and documentation meet CMS requirements for reimbursement and audits.

Proactive case identification, claim presentation, case monitoring and professional management of your bankruptcy accounts. Efficient bankruptcy processes ensure maximum recovery on this type of receivable.

A credit score is a numerical expression based on a level analysis of a person’s credit files, to represent the creditworthiness of the person. A credit score is primarily based on a credit report information typically sourced from credit bureaus.

Self pay segmentation provides an institution the ability understand the financial position of their patients, providing the ability to follow up with them more appropriately and provide a better patient experience.

Identify patient encounters that lead to payment or reimbursement by property and casualty insurers.

Philanthropic organizations fund self-pay balances for Medicare, commercial, and uninsured patients that don’t qualify for traditional safety net programs like Medicaid. Philanthropic reimbursement automation solutions help providers fill coverage gaps to get reimbursed for care delivered.

Reserve Management is the process in which healthcare institutions value their net revenue and accounts receivable.

Specialized follow-up services provide expert and detailed accounts specialists to follow up on targeted accounts receivable to convert to cash quickly.

Under a bundled payment model, providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time.

Experts use industry experience to determine the best productivity solution for business needs by applying technology to day-to-day business interactions.

Ability to facilitate any patient payment within the healthcare ecosystem; includes processing, gateway, terminals, and management tools in one solution.

Price transparency solutions assist healthcare providers by making information available to the public, in a reliable, and understandable manner. The aim of price transparency is to lower healthcare costs by enabling consumers to compare prices and proactively shop for care.

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services

Communicate with your patient across multiple channels across the entire revenue cycle.

In an outsourcing partnership, your partner would assume responsibility for your revenue cycle process encompassing an end-to-end approach of day to day management.

A secure portal to administer, manage and control all payer website access by hospital and physician practice staff. This software increases the productivity and efficiency to access all payor websites and ensures HIPAA compliance by allowing only authorized users access to ePHI and one click de-activation of non-authorized personnel.

Services and solutions that improve E.H.R. configuration and usage, along with end-user work flows, to maximize net revenue, cash flow and productivity

Retiring and archiving legacy systems for compliance, record keeping is a necessity. Archiving enables you to decommission all associated hardware and software after retirement, eliminating the maintenance costs associated with these outdated systems.

Unlocking disparate data in a unified fashion to power enterprise-wide reporting and performance analysis. Provides the linkages of core system data, legacy system data, bolt-on technology data, and select third-party data needed; into a fully unified framework to boost real-time access to data for data-driven decision making.

Artificial intelligence (AI) is the use of algorithms and software to approximate human cognition in the analysis of complex data. AI does this through machine learning algorithms, which can recognize patterns in behavior and create its own logic.

Bad Debt Receivable Purchasing groups, sometimes a collection agency, a private debt collection law firm, or a private investor that purchases delinquent or charged-off debts from a healthcare entity for a percentage of the face value of the debt based on the potential collectability of the accounts.

Collection Agencies are companies who collect unpaid debts for healthcare providers.

A provider’s bad debts resulting from Medicare deductible and coinsurance amounts that are uncollectible from Medicare beneficiaries are considered in the program’s calculation of reimbursement to the provider if they meet specified regulatory criteria.

Vendor Manager software and services deliver healthcare organizations a workable scorecard into the collection agency and other vendor activity and performance; invoice verification technology to ensure commission accuracy, and reconciliation tools to show accounts being worked by the correct vendor according to contract standards.

Under Medicare Post-Acute Transfer rules, certain DRGs are subject to reduced payments if patients are discharged early and receive post-acute care elsewhere. In many cases, patients do not receive the expected post-acute care for reasons outside of your control. Transfer DRG services review claims to ensure claims are coded correctly.

Federal law requires that state Medicaid programs make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. Federal law establishes an annual DSH allotment for each state that limits Federal Financial Participation (FFP) for total statewide DSH payments made to hospitals. Disproportionate Share Software and Services assist clients in filing in accordance with regulations.

Zero Balance or Closed-Accounts Collection Services perform a retrospective review of the claims from a billing, coding & reimbursement perspective in an effort to collect cash not received during the normal collection process.

Applying industry regulations and specific institutional criteria to be sure all Revenue Cycle Billing processes are performing within the specified standards.

Applying industry regulations such as 501r and CMS standards is imperative to develop and implement a strong financial assistance policy and procedure for your institution.

As the healthcare landscape transforms, healthcare providers are being pressured to stay ahead of revenue cycle demands. Changing payment models from volume to value, shifting to increased patient liabilities, and increasing merger and acquisition activity are placing stress on revenue cycles. Health systems are challenged to become more integrated by bringing existing entities together, leveraging economies of scale, and providing cohesive patient service. Revenue Cycle Assessments and Consultants can assist across the continuum.

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with protected health information (PHI) must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance.

Standardize your processes using Lean and Lean Six Sigma to improve care delivery, reduce errors and improve outcomes. Lean Certification training companies offer training specifically designed to develop and implement improvement methods and techniques in your healthcare organization.

Cost reporting and reimbursement consulting services are provided for both cost-based and PPS providers.

Solutions to identify payer-driven revenue leakage, develop strategies to address payer denial tactics, support managed care contract negotiation and effective escalation of grievances with payers.

Interim executive placement firms partner with healthcare organizations to bridge the gap from a vacant position to the hiring of a new, permanent employees.

Interim revenue cycle leadership provides you access to seasoned revenue cycle experts for a period of time to bridge the gap until a permanent replacement is found.

Revenue Cycle executive placement firms recruit and place healthcare professionals experienced in end-to-end revenue cycle solutions in varied capacities. Executive placement of experience revenue cycle personnel can range from sales and in business development, consulting and operations; wherever the critical RCM talent is needed.

Staffing revenue cycle positions across the spectrum until you are able to train and hire can provide a safe gap mechanism to ensure your cash flow position.

Travel nurses are RNs and LPNs, who work on short-term assignments at hospitals, long-term care, clinics, and other healthcare facilities anywhere within the continental United States. Travel nurses provide staff augmentation in areas where there are nursing shortages.