An expert consultant will also guide you through the eligibility criteria and will help you prepare the hospital by identifying important gaps in infrastructure or processes and by solving them as per IRDA and insurance company standards.
Private TPA and government insurance companies have their own set of required documentation, and norms to manage indoor patient file. Usually if the hospital is following NABH guidelines for maintaining medical records, then generally they don’t face any issues with the insurance company’s requirement of documentation.
An expert consultant can train your hospital staff, so that they follow proper protocols in filling up the paper work, and in preparing the patient file.
A consultant for hospital empanelment ( cashless facility ) will also review the hospital’s scope of services, available infrastructure, number of full time and part time consultants, available of critical care services like ICU, number of minimum required beds, allocation of beds, different types of charges charged to the patient, lower and upper ceiling of charges, and more.
Biggest advantage in terms of revenue for the hospital is revisiting and rescheduling various charges. Our consultant will help you optimize your revenue by ensuring your hospital does not undercharge.
Our consultant will also help you with insurance company compliances related to forms, formats, checklists, registers, care plans and more. Same can be implemented directly into the software you use or any HIMS system the hospital is using.
We will help you audit required licenses and certificates required for successful cashless tie up with insurance companies. You can also use our proprietary license tracker available with our CQAS system, to track and manage your licenses.
We will also help you with follow ups and query solving ( most critical part ) to make sure that you are paid in full by the insurance companies, as per the packages determined during a tie up. Many hospitals face substantial loss of revenue and get underpaid by insurance companies, because either the documents are not complete or the forms and formats are incomplete and doctors don’t have time to follow up and resolve all the queries.