Insurance
Reimbursement

Improve workflow and
cash flow with your partners.

Overview

Collecting patient responsibility is only part of the revenue equation, so we provide insurance early-out services as well. We also provide predictive analytics to assess insurance claims denials for trends in order to improve workflows and avoid additional costs and delays in revenue collection. With a strong understanding of the source and cause of denials, we can optimize the workflow between our clients and their insurance partners to improve speed-to-cash and overall financial performance.

Core Benefits

  • Recover more revenue more quickly from insurance partners
  • Uncover the root cause of claims denials to adjust workflows and avoid costs and delays
  • Improved workflow with insurance partners by keeping track of past precedents
  • Insertion of best practices by payer
  • Expert staff with specialization in target insurance carriers
  • Use of good relationship with payer community

How We Work

Process

Our blended process leverages dedicated client centric teams, best practice workflows and state-of-the-art machine intelligence and predictive analytics to recover those hard to collect pockets of clients aged accounts receivables.

 

Technology

Our advantages include:

  • Collaborative data-driven campaigns targeting problematic areas of receivables
  • Technology enabled, rules based workflow management systems for customized client specific campaigns
  • Customized Dashboard/Report Card that tracks performance of KPIs to be reviewed in monthly status meetings
  • Predictive Outcome Analytics to identify, analyze, trend and track historical denial patterns

 

Culture

Under the direction of our senior revenue cycle manager, our teams apply a thoughtful and rigorous process to work mutually agreed upon targeted receivables. Each of our dedicated client teams includes payer experts as well as special team members focused on high dollar accounts. We work hard to earn the trust and confidence that comes with managing payer relationships and optimizing revenue as an extension of the hospital’s business office.

“Success is no accident. It is hard work, perseverance, learning, studying, sacrifice and most of all, love of what you are doing or learning to do.”

— Pele

Alphalytics™ – Predictive Denial Avoidance Solution

Our Alphalytics™ Software-as-a-Service identifies likely denials enabling clients to take action preventing future payment delays and lost revenues.  This solution aggregates disparate data streams into one application; then utilizes advanced predictive analytics to reveal root denial causes originating from seemingly unrelated data.  The metrics, reporting, and benchmarking modules in Alphalytics™ provide revenue cycle professionals, clinical leaders and care managers with timely, actionable insights that accelerate decision making.

 

Alphalytics™ helps hospitals and health systems:

  • Confidently pinpoint denial root cause sourcing to specific facilities, departments, specialties, physicians and payers
  • Provide the intelligence needed to develop and implement actionable prevention strategies, along with mapping priorities with the highest impact
  • Improve first-pass performance by reducing initial denial rate
  • Reduce initial denial rate by using automated data mining to highlight non-obvious factors causing denials
  • Identify process improvement opportunities and track process change effectiveness
  • Improve operations by predicting revenue leakage through root denial cause analysis, validating contract management accuracy, and providing benchmarking reports
  • Validate accuracy of contract management application
  • Generate revenue cycle reports including payer and facility benchmarking
  • Gain visibility via daily updated dashboard, benchmarking and standardized reports
  • Eliminate information silos by sharing care management and revenue cycle data across departments for greater efficiency

Revenue Recovery Services

Contract Payment Auditing Program

Many healthcare providers struggle to manage differing payment contract terms from numerous payers. We leverage our experienced staff to rigorously research historical and closed accounts, identify payment discrepancies and recover shortfalls that would otherwise be lost revenue.

 

Denial Management Services

Providing the highest possible overturn success rate without taxing facility resources. Our in-house clinicians compare payer determinations with medical records and prepare a clinical appeal response when necessary. Our Predictive Denial Profiles expose root causes, enabling clients to take action to prevent future delays or lost revenue.

 

Transfer Diagnosis Related Group (DRG) Services

Maximizing inpatient payments by comparing Medicare GLOS and ALOS figures, reviewing Common Working Files and IVF, reviewing adjustable cases and rebilling, following-up and adjusting claims until account is paid or closed.

 

Radiation Oncology Insurance Services

Utilizing a network of current and former administrators, therapists, physicists, managers and experienced staff, we assist health systems and stand-alone centers with:

  • Billing and recoveries
  • Authorization analysis
  • Charge capture audits
  • Documentation reviews
  • Charge master analysis
  • Policies, procedures & training