Managed Care Solutions
We specialize in assisting Manage Care Organizations, HMO’s, IPA’s, PPO’s,PFFS etc to enable them to offer high quality of care at contained costlevels. Organizations require the agility to quickly respond to market demands,regulatory changes and new customer requirements. Guhilot provides managed care organizations (MCOs) with real competitive advantage by simplifying processes, improving productivity and providing the data to shape management decisions, leading to a financially successful organization.
We have been in the managed care business since 2005 ensuring that all our customers remain at the forefront of frequent changes as they happen.The move to value-based care and widespread variability in care means quality measurements now play an integral role in strategic health care planning. Industry stakeholders need reliable provider quality information to guide decisions around new payment and delivery models, plan performance and tiering, network management, provider reimbursement,risk management, and contract negotiation. In order to achieve our customers goals, we use advanced healthcare information tools and systems driven by both human and automated healthcare business processes to deliver integrated solutions focused on quality. We provide secure and compliant data acquisition, processing, and management by following industry standards and formats.Our decades of expertise in the managed care business ensures that our provider networks stay focused on effective patient care while we manage work in the background help navigate the compliance and service delivery objectives.READ MORE
Risk Adjustment Solutions
The shift from fee-for-service to value-based care is ushering in a new reality—and new complexities—for payers and providers. Health care organizations participating in value-based payment models are quickly learning that accurate and complete risk adjustment coding is critical, as it impacts everything from risk-adjusted revenue and overall financial performance, to quality reporting and care planning and delivery Guhilot Health provides comprehensive risk adjustment solutions for health plans, managed care organizations and other risk-bearing entities.
We provide ongoing insights to understand the drivers of medical and financial risk and the ability to take action grow revenue through a combination of services such as medical record retrieval, medical record coding by certified coders, identification of documentation of service gaps and both member and provider engagement services that close those gaps.The revenue optimization process involves risk analysis, which calculates historic and potential risk scores and determines suspected morbidities leading to both revenue optimization and cost containment opportunities.READ MORE
DME Home Health Solutions
We have an expertise in providing end to end process for DME vendors which help them streamline their order-to-cash processes, Efficient Delivery and high customer satisfaction while maintaining high Quality Standards. We have a blend of technical and analytical capabilities that facilitates the customer to ensure smooth and timely delivery at all times. We work closely with our partner DME vendors to perform operational activities right from receipt of Authorization requests and other documents from payers, medical groups, hospitals and Medical Offices, insurance verification, order processing and other related activities till the delivery of equipment. We have a deep insight of all DME products including but not limited to Routine DME, Respiratory Therapy, Oxygen supplies, Custom and power mobility, Orthotics and Prosthetics, Enteral Nutrition, Wound Care, Incontinence supplies, Infusion therapy and other miscellaneous DME products.
We work hand-in-hand with health plans, managed care organizations,doctors, hospitals and hospice agencies to help create a positive experience in delivering quality homecare equipment and services to the patients they care for. Our unique approach to customer service, combined with our cutting-edge technology knowledge gives us the ability to assist our partners with achieving timely and improved outcomes. Our fast response times and clear communication channels consistently achieve superior patient satisfaction results.READ MORE
Revenue Cycle Management
Revenue Cycle management is a very complex and laborious process and if not done correctly, directly affects the financial well being of your practice. Also, it is necessary to perform these services on are regular basis without any break. It needs to be done correctly firsttime every time. Coding mistakes costs the organization lot of money and regulatory compliance issues. This also leads to lower satisfactory levels of your patient thereby affect the reputation of your practice in the long run.Moreover, steps involved are hard to manage especially the medical coding, multiple payer contracts enforceability and AR. To compound matter there is regular staff turnover which leads to backlog and huge AR that becomes impossible to resolve as it goes beyond 90 days.
That is why we recommend outsourcing our billing requirements to partners like us. We are focused and certified group of medical billers and AR executives who are trained to cater to all your needs on a consistent basis.We pride ourselves in helping our customer achieve higher profit margins from very first month of engaging our services. We assure you as a clinic,physician or a hospital receive the maximum revenue approved in the shortest time.Our all-inclusive revenue cycle management solutions have been in use and perfected for over a decade to ensure your start seeing results from the first month itself.READ MORE
Healthcare Quality Measures Solutions
Collect, Analyze, Communicate, and improve your clinical and financial performance
In order to improve the quality of healthcare, NCQA has various programs that help is measure and report the levels of healthcare services. One such programs Healthcare Quality measures is one of health care’s most widely used performance improvement tools.More than 190 million people—over half our country’s population—are enrolled in health plans that report quality results using our Healthcare Effectiveness Data and Information Set.Americans receive better care and can lead healthier lives thanks to the accountability and benchmarking that Healthcare Quality measures makes possible. Health plans that want to acquire accreditation through Healthcare Quality measures are required to gather data about patient care, organize it into specific measures defined by Healthcare Quality measures and determine if specific criteria for Healthcare Quality measures measures have been met. Guhilot Health’s Healthcare Quality measures Review process is designed to optimize the time and resources spent on chart review and organize the records and results in a meaningful and effective manner. READ MORE
Accounts Receivable Management
Insurance & Patients accounts receivable management and bad debts are a very common problem with all types of healthcare organizations. This causes a reduction in cash flow and loss of revenue unless it is handled in a timely and methodical manner. Healthcare organization usually struggle to handle their bad debts and accounts receivables as they understaffed and have unqualified medical billers on their payroll who are unable to navigate the increasing complex nature of the healthcare industry.
At Guhilot, we have a large pool of medical billing AR executives and medical billers with over 15 years of healthcare industry experience that help identify and mitigate all causes of revenue loss. Over the years have developed tools and processes that have been developed after lot of practical insights to hand medical billing insurance accounts receivables and medical billing bad debts. These tools and processes have been able to help our customers recover ever older than 2 years of bad debts that other medical billing companies have given up on. We do all this with complete transparency through our custom mobile apps and easy to understand reports clearly showing the progress.READ MORE
Medical Coding and Billing Services
A medical coding & billing service is the doctor’s key to getting paid. Even though it is most basic and important activity of any practice, most doctors and healthcare providers have no idea how to get themselves paid quickly and efficiently, if at all—either by insurers or by patients. Most doctors do not take into considerations that efficient billing services requires up-to-date knowledge with ever changing coding regulations and practices. For doctor to get paid correctly, bills must be generated with most appropriate codes for the services rendered and should be timely submitted taking date of services into consideration.
To make matters worse, private, and government-administered insurance companies, HMOs, PPOs, etc have various types of plans with varied Co-pay, Deductible, out-of-Pocket Maximums, Co-Insurance, primary & secondary insurance, etc. that makes getting re-imbursed very complicated and lengthy process. Moreover, it is observed that once the bills are sent by the billers, there is hardly any follow-up by the billers, leading to large accounts receivable mostly due partial payments or pending patient amounts.
Doctors, once the centre of healthcare world, are finding it almost impossible to keep up with their payments leading to lower profits and even losses. But not to worry, Guhilot’s end-to-end Medical Coding & Billing Services can help you navigate this maze with ease. With large pool of certified medical coding & billing executives, Accounts receivable executives, latest software’s & technology solutions, and mature processes, we will help get you paid correctly and on time leading higher profits almost immediately.READ MORE