Cephal

Along with RCM system, equally important to have an experienced medical coders and other supporting RCM operational resources for effective RCM outcome.

Hospital requires qualified resources to successfully navigate the RCM process, a great deal of training is required to ensure compliancy. However, given the high volume demands of the billing process, finding the time for proper training and right resources can be a challenge – not to mention expensive. Many hospitals consequently struggle to ensure that their RCM department receives the instruction, support and resources to function efficiently and accurately.

Cephal offers RCM professionals who are qualified medical coders and experienced in RCM process

Specialized resources are required for following process

Pre-authorization and eligibility verification

When a patient makes an appointment, the healthcare provider collects information to establish a patient insurance eligibility.

Charge capturing and Medical coding

Charge capturing is the process by which patient services are transcribed into billable charges using universally accepted medical codes. These codes are how insurers determine reimbursement amounts. Without proper medical coding, the insurance company may deny the patient’s claim. This results in delayed provider reimbursement.

Claims submission

Once a patient’s treatment has been properly coded and audited, the claim is sent to the insurance company for approval. RCM ensures this submission happens quickly by tracking and managing the claim from the start of the process.

Payment collections

Once the patient’s claim has been approved, the insurance company reimburses the provider based on the patient’s eligibility.

Medical service review

Thorough revenue cycle management encourages care providers to analyze clinical treatment data. Analyzing this data allows providers to pinpoint steps in the cycle where errors are being made and identify ways to lower their expenses. In turn, this will help increase provider revenue and improve the patient experience.

Other
Services

Our Services

Data Clearing House

Cephal Healthcare Data Clearinghouse provide the ability to take in non-standard data and process it into standard data formats that can be ingested into any pertained regulatory bodies, insurance payers, healthcare Analytical tools…etc.

Data Cleansing

Cephal Data cleansing or data cleaning is to detect and correct corrupted or inaccurate records from patient record set, table, or database and refers to identifying incomplete, incorrect, inaccurate or irrelevant parts of the data and then replacing, modifying, or deleting the dirty or coarse data.

Revenue Cycle Management System

Revenue Cycle management (RCM) is the financial process between healthcare providers and insurance payers, where utilizing the right RCM technical tool and process that facilitates to process the claims activities more efficiently and effectively.

Pharmacy Benefit Management

Cephal Pharmacy Benefit Management is an automated Clinical Screening Solution, using technology to support clinicians with making better informed medication-related decisions. It is designed to alert clinicians and pharmacists making prescribing decisions to information about avoidable medication errors, inappropriate dosing and adverse events.

Claims Audit - Patient Record Audit

Group of trained RCM professionals (internal or outsourced) who are involved with the patient from the start of their care to the very end when payment is made. They assign appropriate codes based on a patient's record and bill. These codes are made into Pre-approval & claims that are sent to the patient's insurance company/TPA.

Claims Analytics - Medical Data Analytics

For Healthcare providers, revenue cycle management is an integral - but complicated component of ensuring an organization runs efficiently and effectively.

Medical coding and Audit Tool

Medical coding can be incredibly laborious to assign medical codes. The complexity of the medical coding process has increased due to the latest healthcare reforms. There is demand for perfect documentation and its coding. Anything less than perfect, means, rejected claims, or, worse still, fines for miscoding.

Revenue Cycle Management - Operation