MedCare MSO’s ambulatory billing software guarantees accurate ICD-10 coding and automates the submission of surgical claims. It provides your ASC with complete control over its revenue cycle from pre-authorization to final payment.
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Each module is designed especially for outpatient clinics and ambulatory surgery centers, removing the billing bottlenecks that cost you money.
Using AI to automatically recommend CPT and ICD-10 codes from clinical notes removes missing charges and lowers human coding errors at the point of treatment.
Find payer-specific problems, missing data, and coding errors prior to submission. High- risk claims are identified by predictive rejection analysis before they are removed from your system.
Before the procedure, it instantly verifies the patient's insurance coverage, co-pays, and pre-authorization requirements to ensure your AR is free of surprises.
AI automatically creates appeal letter text, classifies and patterns denials, and suggests coding and documentation changes to avoid rejections in the future.
Keeps your books accurate without requiring additional labor by automatically matching EOBs to patient accounts and highlighting differences between expected and received payments.
Monitor payer performance, denial rates, and AR days in real time. Determine high-risk accounts and forecast cash flow before they affect your bottom line.
Use AI to get rid of missing charges and coding mistakes. Our ambulatory coding software reduces human error and increases first-pass acceptance rate by automatically suggesting correct CPT and ICD-10 codes based on real-time reading of clinical documentation.
With the help of our ASC billing software, claims processing is converted from a labor-intensive, manual process to a completely automated pipeline. Before being submitted, claims are checked against payer-specific rule sets, and AI-driven predictive rejection analysis finds issues that human reviewers overlook.
One of the main reasons for ambulatory billing delays is coverage surprises. Prior to the patient’s surgery, our technology instantly confirms insurance eligibility and benefit data. When a service needs pre-authorization or might not be covered, automated benefit alerts promptly warn staff and allow your team to take proactive measures.
Denials are not only handled by our ambulatory surgery center billing software, but they are also avoided. AI automatically creates customized appeal language, finds patterns, and examines each denial by reason code.
The proper dashboard is the first step in data-driven revenue cycle management. Every important financial data, including A/R aging, rejection rates, payer performance, and cash flow estimates, can be seen in real time with our ambulatory billing system.
Transform your clinic’s billing process with our AI-powered ambulatory billing software. Reduce denials, automate claims, and speed up payments.
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The compliance codes that are generated through our ambulatory coding software continue to convert clinical documentation into the correct compliance codes through the use of NLP-intelligence. Procedures are mapped to diagnoses, unbundled codes are found, the usage of modifiers is checked, and comments are adjusted to the payer-specific requirements. The technology eliminates the errors that cause audits and denials by harmonizing your entire workforce of ASC in terms of their code logic.
The indirect costs related to manual ambulatory billing operations are staffing, training, reimbursement, and unsuccessful claims, each with a cost to fight of between 40-120 dollars. The loss of tens of thousands of dollars a month as a result of one preventable wave of denials can be encountered by a mid-sized ASC. By automating charge capture, cleaning claims before to submission, and identifying odd billing trends that may lead to audits, our ASC billing software removes these risks.
In ambulatory centers, billing personnel spend hours every day entering data, manually verifying eligibility, making payments, and following up on claims. These and many other processes are automated with our ambulatory billing system that posts payment based on EOBs in real time, intelligently routes jobs, and only presents exceptions that need human intervention. Members of staff spend hours saved every day to focus on patient facing work and exception management instead of dull administrative tasks.
Our system has a lifecycle tracking of every claim and is integrated at the point of care. The real-time billable activities are recorded by the software once a visit to a patient begins. It does so by extracting clinical data out of your EHR, verifying eligibility, and recommending codes without human intervention. The claim is automatically assembled, evaluated to have payer adjustments and submitted electronically following the end of the encounter. Payment is automatically debited to patient accounts and any rejection triggers an artificial intelligence workflow, which categorizes the issue, provides a solution and initiates an appeal procedure.
Our medical billing software for ambulatory centres is purpose-built to handle the unique requirements of your revenue cycle management.
The core of our ambulatory billing system is HIPAA-secure. Every piece of patient health information (PHI) is safeguarded during its collection, processing, transmission, and storage, guaranteeing that your facility complies with regulations without incurring extra costs.
Every tier of the system is subject to SOC-2 security controls and NIST cybersecurity framework standards. For healthcare enterprises of all sizes, encryption, ongoing monitoring, and access verification satisfy enterprise-level data security requirements.
In transit and at rest, all payment records, claim files, and billing information are encrypted. Multi-layer encryption technologies prohibit unauthorized access at any stage of the revenue cycle activity.
User role controls access to financial reports, patient records, and billing information. Certain information can only be seen, edited, or exported by authorized personnel, lowering the risk to internal data while preserving a thorough, verifiable access history.
Time stamps, user identity, and change records are recorded for each activity made in the ambulatory billing system. With little extra work, these comprehensive audit trails facilitate regulatory reporting, external audits, and internal compliance checks.
Our self-learning AI keeps an eye on billing trends throughout your institution and highlights unusual activities that might point to fraud or billing problems. Compliance officers can look into and fix problems before they become exposed to regulations.
Our ambulatory surgery software seamlessly integrates with your existing EHR systems. The technology pulls clinical information, patient demographics, laboratory findings and scheduling information out of your EHR through HL7, FHIR, X12 and secure API connections. It subsequently forwards clean and tagged claims to payers and directly refunds money to patient accounts.
Our platform is tailor-crafted to address the particular needs of payers, code sets, and billing requirements of outpatient clinics and ambulatory surgery centres. It handles ASC-specific CPT and ICD-10 coding reasoning, facility billing, and the activities involved in the revenue cycle that pertain to high-volume outpatient settings, as opposed to general office visit billing model most platforms are developed on.
Indeed. The ambulatory billing system provides over fifty specialties with payer adjustments, documentation requirements, and code logic specialty-related. The platform will automatically assign the right set of criteria to each kind of case, regardless of whether your ASC deals with orthopedic, GI, ophthalmology, pain management, or general surgery cases.
In the initial 60 to 90 days of implementation, a noticeable reduction in denials is seen in most facilities. The AI-based predictive rejection analysis and automatic scrubbing immediately increase first-pass acceptance rates, and, as the self-learning denial avoidance engine learns the individual payer behavior of your institution, the benefit increases over time.
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