Gemcaps is a medical billing and technology company that provides services and software to manage and grow the revenue for outpatient provider clinics. What makes Gemcaps unique is the approach of utilizing a hybrid model of outsourced and stateside resources as well as leveraging technology to address each client’s respective needs and priorities.

The overarching vision is to enable healthcare providers to focus on giving the best care possible to patients by removing as much concern as possible from the business side of the practice. All healthcare providers invest many years of school and large sums of money to become experts in providing care to patients under a specific specialty, but managing insurance billing revenue and operating a business should not be taken lightly nor is it easy. We believe that for outpatient clinics the business side is almost equally as valuable because we understand that the revenue generated from insurances can be complex and, if not managed well, can take away from a healthcare provider’s focus or ability to provide care to patients. Not only do we look to manage the revenue, but whenever possible, optimize and grow the revenue, which hopefully leads to providers being able to expand positive impact on their patient population.

Gemcaps has been in business for just over 5 years starting back in 2019.

Gemcaps serves the healthcare industry, specifically outpatient or private medical practices.

The core of our business is providing medical insurance billing services. This includes services such as working on legacy AR projects for claims approaching timely filing, credentialing with insurances, verification of patient insurances, prior authorization management, medical coding for notes, insurance claim submission, management of denials, rejections, and appeals, follow-up on patient balances, and account receivables management.

Additionally, we have created a business intelligence tool that is specifically built for understanding and evaluating insurance billing performance tailored to each specialty.

Medical practice and healthcare technology consulting is another service we offer should a business want assistance from beginning to end to maximize the best chance of success. This includes everything outside of providing care to patients such as evaluation of the entire business’s needs and finances, patient population, patient journey workflow creation, staffing and software recommendations, and performance evaluation.

What differentiates Gemcaps from its competitors is the hybrid model of stateside and outsourced resources as well as being able to easily show the benefits of technology. From the beginning, Gemcaps identified the growing challenges in the outpatient practice space as costs continued to increase from technology requirements from electronic health records systems, various patient enablement platforms, and staffing needs. The options for an outpatient practice to manage insurance billing were either using services from an electronic medical records company, which creates a middleman for pricing and quality of service, or staffing a medical biller which can be high in cost for a growing business and often difficult to scale in size.

The hybrid model that Gemcaps offers removes the middleman that electronic medical records companies create and better enables a practice to scale as we can always be competitive in both price for services and staffing, while still offering stateside attention to detail and communication.

Costs for services vary based on services needed but our fee for standard medical billing management is a percentage of net insurance payments to the client. The percentage can range from 3-8% based on average monthly insurance appointments and average net insurance payments.

Fees for additional services such as prior authorizations, insurance verifications, coding, staffing, and others can either be monthly recurring or included as part of the percentage-based fee of collections based on average monthly volume.

Price for services such as credentialing or consulting can be one-time payments or various installments upon completion.

Software fees are a monthly recurring fee based on the plan type and size of the practice.

Do you work with new or practices starting out?

Yes, we work with practices of all sizes regardless of whether the practice is brand new or has been in business for many years.

Do your employees outside of the United States work in our time zone?

Yes, all teams have coverage for all US-based time zones, including Hawaii and Alaska.

How quickly can you start working on my insurance billing?

This answer varies depending on the size of practice and service needs. At times we can start within a few business days for low volume and low needs but for larger practices and to ensure a successful transition where revenue is not significantly impacted, we require more time to learn the business workflow and confirm the proper team is in place to manage that volume and workflow.

Podiatrist Dr. Adam Seigel said:

“We couldn’t be happier with our partnership with Gemcaps! Their state-of-the-art technology and exceptional services have been instrumental in supporting the expansion of our medical practice. Working with a partner like Gemcaps has revolutionized our revenue cycle, enabling us to provide unparalleled patient care and confidently expand our services. With the help of Gemcaps we have been able to rapidly expand from 3 offices to 14 in the span of two years. Knowing that all medical billing was in the hands of Gemcaps allowed our executive team to concentrate fully on our expansion.”

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