Healthcare ERP for United States

Revenue cycle management in US healthcare involves coding patient encounters using ICD-10 diagnosis codes and CPT procedure codes, submitting claims to commercial payers, Medicare, and Medicaid in ANSI X12 837 format, managing denials and appeals, and posting payments from multiple sources. The No Surprises Act enacted in 2022 prohibits balance billing for emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities, requiring price transparency and independent dispute resolution processes. Medicare reimbursement follows the Physician Fee Schedule updated annually with conversion factors and relative value units.

Operational costs for US healthcare organizations include staffing expenses that represent over 50% of total costs, medical supply procurement where group purchasing organizations negotiate contracts, and technology infrastructure that must meet Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs. Compliance with CMS Conditions of Participation is required for facilities receiving Medicare and Medicaid payments.

Yukti provides healthcare organizations with administrative and financial management that maintains HIPAA compliance through role-based access controls, audit logging, and encrypted data handling. The revenue cycle module supports ICD-10 and CPT coding with claim scrubbing before submission, ERA/EOB processing for payment posting, and denial management workflows. Financial reporting meets CMS cost report requirements and supports the Medicare wage index and case-mix index calculations that affect reimbursement. Supply chain management integrates with GPO contract pricing and tracks usage at the department and procedure level. The system handles the No Surprises Act requirements including good faith estimates and the independent dispute resolution process documentation.