Maximize Efficacy with our Revenue Cycle Management Solution
Save valuable time and increase ROI with this cost-effective solution.

Overview

revenue-cycle

Modules: Rules Engine, Payor Management, Inpatient Billing, Outpatient Billing, Eligibility & Authorization Management, Scrubs & Claims Processing, Receivables Management, Cash Management, Revenue Cycle Daily Intelligence

Financial stability remains the focal attention of management in ensuring that organization remains resolute in the pursuit of its vision. Sensible discipline of financial prudence, sustained by sound revenue and receivables management, hold key to steadfastness of the institution.
The full revenue cycle is ordained with complex, mundane and equally challenging processes and procedures, all the traits of work environment that needs to be performed within an organized, controlled and above all automated. Only then can operational efficacy and optimal profitability be sustainable. Setting pricing mechanisms, managing patient care flows, ensuring comprehensive charges capture, clinical and administrative documentation, coding, provider payables, claims management, denials resolution and financial integration are some of an endless list of processes that can go awry and derail organizational focus if standards, controls and automation remain a lack.

GCI Revenue Cycle solutions and technologies built within and around sophisticated in-house Rules Engine and Application Configuration Tools helps disciple/define/build complex rules and conditions and near-impossible business process flows with utmost ease and simplicity.

Feature

Rules Engine

The Rules Engine forms the core of the entire Business Suite. The engine provides ultimate flexibility to define any and all rules conditions, processes, alerts and workflows that enable an almost a flawless and human-effortless environment.

Salient features include:

  • Ability to translate contracts line by line.
  • Diagnosis based exclusion.
  • Handles Exclusions, Deductibles, Coverage etc.
  • Specific Requirements like Deductibles on Gross, Deductibles on Net.
  • Patient Level Policy definition to handle Eligibility and Charity Patients.
  • Multiple payor to single patient
  • Ability to define Rules Based on any information and combination
    • Service group , Category , Item Code
    • Medicine Generic, Medicine Form, Medicine Category, Medicine Code
    • Patient Sex, Patient Age, Patient Nationality etc.
    • Diagnosis Code
    • Doctor Specialty , Doctor Sub Specialty , Doctor Type
    • Encounter Type (Inpatient, Outpatient, ER)
    • Bill value etc.

Payor Management

Healthcare providers today render services within a complex payor environment. Government, employers, insurance companies, charities typically form part of a major and varied source of healthcare payor groups. Each group, in offering serving as a payor for care seekers, has its own set of policies, procedures, guidelines and limitations that govern payments for patient care.

These payors enter into contracts with healthcare providers or patients. The rules, policies and conditions contained in these contracts are the basis on which the payer will make payment. These contracts terms and conditions can be as diverse as the care seekers they cover. Healthcare providers seeking to manage the eligibility of their patient whilst ensuring optimal care, all within a manual environment will undoubtedly be faced with a monumental task of managing their billing, claims and receivables processes.

GCI’s myCARE Payor Management System provides the ideal solution, automating any or all contracts accepted by the practitioner / hospital and enabling real time and automatic processing of eligibility checks during the ordering process itself.

With this automatic process in place the practitioner or hospital is able to assure themselves that any or all services provided their patients are fully covered. This limits the need to manage denials, collections and delays in receipts due to an improper contract management environment.

Patient Billing

In an increasingly competitive marketplace where healthcare costs are burgeoning and healthcare providers and payors alike are expected to control costs while maintaining business growth without the compromising exemplary patient care and positive health outcomes, the ability to manage data into information for rapid decision making in patient care is becoming imperative

GCI’s Patient Billing System is a leading part of the Business Office Solutions of myCARE’s Healthcare Applications Suite. The module flexibly and comprehensiveness provides a platform for charging, tracking and consolidating billing information across the healthcare facility that enables full command of a business process environment, maintaining cost controls and revenue management. Charges can be entered directly, within other modules of myCARE and/or via interface with external systems.

The module’s core is its rules-building engine which validates the eligibility status of every patient for any and all services that may be requested. The flexibility of the user-definable rules-engine, which requires practically no manual intervention in the determination of eligibilities, differentiates GCI’s Patient Billing Module from the alternatives.

  • Master Patient Index;
  • Registration; Pharmacy;
  • CPOE; Laboratory; and
  • Radiology amongst others.

It also acts as the feeder data source for

  • Approvals Management;
  • Claims Management (including e-claims),;
  • Accounts Receivable; and
  • Provider Payables, among many others.

Key Features

  • Built to accept information and integrate with any feeder system that complies with accepted norms of standard information exchange;
  • Robust rules-building engine that is required by electronically business scenarios of any nature;
  • fuses into the overall system and helps maintain effective cost controls and revenue management;
  • User friendly, multi lingual interface;
  • Exceptional user-definable reporting and MIS environment are defaults.
  • Flexible Rate Definitions; multiple rates definable
  • Industry Standards Compliance: HL7, ICD, CPT amongst others
  • Workflow Based System; easy configuration of work processes, policies, procedures…
  • Package Definitions; easy of defining any and all Inpatient, outpatient, daycare and any other type of packages
  • Configurable Financial Concepts; Flexibly Supports one or more or combinations of
    • Financial Concepts eg:
      • Pay As You Go
      • After the event
    • Centralized / Decentralized Cashier.
    • Approval Hierarchy for Refunds and Cancellations.
    • Outpatient Deposits and service availed against deposits.
    • Family Tree advance receipts / offsets handling (VIP)
    • Paperless Environment; dealing with payors, administrators, referrals etc

Eligibility & Authorization Management

Monitoring patient eligibility to healthcare services treatment based on respective coverage is made absolute at ease with the rules and conditions are duly and aptly defined within the system with the flexibility and functionality provided by the rules engine.
Alerts are duly triggered with services ordered are not covered. This automatically generates an approvals request or redirects the process to a predefined workflow for further action as appropriate.
Preapprovals and related requests are predefined and can be executed based on predefined workflow processes and documentation flows. These can be a fully electronic environment depending on the support and integration enablement of the payor environment

Audit & Claims Processing

The Claims Processing procedure within the system is by all counts an exceptionally simplified process. Prior to finalization, Claim Audit processes are performed to ensure completeness and comprehensiveness. Editing the claims are permitted with appropriate user authorization

There is no need to have a clear definition of claims “period”. Accruals basis of revenue recognition is defaulted
Claims can be in traditional manual form or thru paperless electronic environment. Claims submission can be multi-tied to include third party administrators and/or directly thru to principal payors

Receivables Management

Accounts Receivable is an integral sub-module of the ExChequer Financial System. It is seamlessly integrated with myCARE Order Management, Billing and Invoicing (e-claims) modules.

Detailed analytics within the systems enabled by strong drill down features, data export features and configurable aging reporting views all consummate to provide unparalleled management information that helps drive better internal controls, cash flows and customer management
The Receivables module can also easily import order, billing and invoicing data from third party legacy systems.

Real time and seamless integrations with Cash Management, Accounts Payable and other ExChequer modules enables state-of-the-art cash management, laudable customer management and excellent management information that can help drive good revenue policies and receivable controls management

Auto or manual /batch or real time postings to Accounts Receivable are optional. Flexible aging analysis provides comprehensive and all-inclusive view of the status of collections.

Cash Management

GCI’s Cash Management module enables effective control of cash that flows into the organization. The control mechanisms built in will enable proper recording of cash receipts, effective reconciliations on a daily basis and management of banking procedures. Non-cash transactions; credit cards, checks and all other recognized forms of payment within the organization are also effectively controlled and managed. This ensures all authorized best practices are fully adopted.

Appropriate segregation of duties, approval authorities, and management controls are easily configurable to enable the organization to effectively manage cash flows within the entity.

Bank Reconciliations are automated and can seamlessly link and download from bankers’ software; reducing the mundane efforts of performing manual reconciliations.

Quick and simple views, as required, are easily configurable. Extensions and integrated environments with the other ExChequer modules enable effective management of payable and receivable cash flows thus providing an exemplary environment for effective cash management and controls

Revenue Cycle Daily Intelligence

The data and information structure is defined across the entire spectrum of modules / applications. The ability to extract and analyze clinical, financial and administrative data provides the organization with the tool to instantly and in real time understand the environment and provides a sound basis for better decision making.

For the daily and regular chores, exceptional number of predefined reports are available as part of the library. User definable reports are enabled to allow the astute user the flexibility he or she requires from the system / information.

Benefits

  • Automate and streamline the revenue cycle processes
  • Enhance Revenue Generation
  • Rules based workflow, which improves efficiency throughout the entire medical billing process
  • Decrease days in A/Rand improved and accelerated reimbursements
  • Save time and resources which increase the ROI

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“Revenue Cycle Management”



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