Services

Services

Healthcare providers face various problems, which can impede their financial performance –rising care costs, alternative payment models, growth through consolidation, consumerism, and the desire for a better patient experience.
HOM helps navigate through these challenges, by providing end-to-end operations management solutions fueled by intelligent automation and proven practices spanning all settings of care.
With HOM, healthcare organizations will have an ideal revenue cycle – one that fosters higher patient satisfaction, reduces costs, and improves revenue.

Revenue Cycle Management Services

Comprehensive RCM

HOM provides one-stop solution for all revenue cycle management services, we help in reducing operational costs, improving turnaround time, and increasing revenue.

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Pre Visit

Demographic Entry

Collection of patient information and consent required for the medical record in order to meet established clinical, financial and regulatory demands.

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Prior Authorization

Procedure of obtaining prior approval from the payer(insurance company) before the healthcare provider offers services to the patient.

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Eligibility Verification

Validating patient’s eligibility and benefits to ensure provider receives payment for services rendered.

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Claim Prep

Coding

Identification of medical diagnoses and procedures and documenting them in a patient’s medical record as universally accepted codes.

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Billing and charge posting

Recording information about the services provided into a medical claim for billing.

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Claims and Adjudication

Determines the amount of reimbursement that the healthcare provider will receive after the insurance company clears the dues.

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Utilization Management

UM is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis.

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Essential Value Adds

Clinical Documentation Improvement

Ensuring that the events of the patient encounter are captured accurately, and the electronic health records properly reflects the services that were provided.

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Credentialing and Contracting

Credentialing process validates that a physician meets standards for delivering clinical care wherein the insurance verifies physician’s education, affiliations, licenses, certifications, training, malpractice and any adverse clinical occurrences.

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Referral Management

Referral is the process of sending a patient to another practitioner (ex. specialist) for consultation or a health care service that the referring source believes is necessary but is not prepared or qualified to provide.

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HEDIS

HEDIS® is a set of standardized performance measures developed by the NCQA to objectively measure, report, and compare quality across health plans.

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Receive Payment

Payment/ ERA posting

Reconciling the payments received from the insurance payer to each individual claim. Once payments are posted, any secondary claims can be created and submitted.

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Denial/ AR Management

Tracking and managing unpaid claims ensuring that no time is lost on pursuing every reimbursement possibility.

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