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.

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.

Prior Authorization

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

Eligibility Verification

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

Coding

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

Billing and charge posting

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

Claim Management

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

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.

CDI/Chart Prep

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

Credentialing

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.

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.

Quality (HEDIS)

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

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.

Denial/ AR Management

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