An efficient revenue assurance program is critical to sustain the financial health of healthcare organizations. We deliver accurate and compliant revenue capture, improve clean claims submission, and process payments efficiently. Our proprietary technology platforms help you realize the reimbursements due to you and minimize risks.

Accounts Receivable Management

Ensure receivables are converted to revenue quickly and effectively to accelerate cash and reduce AR days. Our A/R follow-up solutions include:

• Follow-up with insurance companies. We make omnichannel contact with insurance companies via Website, IVR, and Phone to get the claim's status. Our technology solution enables automation of claims status processes and reduces the costs of follow-up. The solution also improves website adoption through secure login management. 

• Effective action plan. We just do not get the status of the claim but also go a step further to refile claims and appeals with due documentation. 

• A/R KPIs. We strive to adhere to HFMA and MGMA benchmarks.

• A/R policies and procedures.  When it's about A/R, it's good to go by the book; we work with our clients to develop policies and procedures for A/R follow-up, denial management, and reporting.  As A/R falls out of range, we work with clients to move old A/R into collections processes. 

Denial Management Services

Over 65 percent of claim denials are never appealed, and it costs $25 to appeal each denied claim. With over 20 years of experience in working claim denials, we understand that each claim denial is unique and requires focused efforts to resolve the issue. At Access Healthcare, we bring strong capabilities in A/R and denial management. Our denial management services include:

• Denials processing:

  • Understanding the typical denial reason codes, i.e., both ANSI and payer-specific denial codes

  • Analyses root cause of each claim and files appeals with insurance companies

  • Where appropriate, transferring the responsibility for payment to secondary insurance or patients as appropriate.

• Trending of denials and creating automated workflows

• Denial analysis and underpayment reviews

• Clinical denials – review and appeals. We correct medical codes, provide clinical documentation, and file appeals in payer-specific formats.

• Appeal templates automation

• Training of clinicians and revenue cycle team on preventing denials

• Focus on denial prevention through root-cause analysis

Shifting the focus to denial prevention

We look at top reasons why claims have been denied to drive focused efforts on preventing denials. We work with clinicians and medical coders to eliminate the root cause.  We work in an iterative model to reduce denials each month. 

Dealing with Clinical Denials. Clinical denials are on account of coding errors. We utilize our coding team to correct medical codes as per AMA guidelines and apply CCI edits. Our coding denial management team understands the need to check medical necessity, improve clinical documentation, and works with clinicians to reduce clinical documentation issues.

Payment Variance and Credit Balance Services

Our payment variance and recovery services include:

• Lost revenue assessment. We can help you identify contractual underpayments by performing an in-depth analysis of all services against the contracts. We use your contract management software and experienced auditors to identify underpaid claims. 

• Underpayment recovery services. We analyze payments against contracts to identify underpaid claims and appeal with payers to collect due amounts.

• Retrospective underpayment review. We look at historic underpayments to identify the overall impact of underpaid claims as well. 

• Refunding credit balances. Credit balances are a compliance issue, and timely refund of money to patients and payers is important.  We process patient and payer credit balances.

Self-Pay and Patient Follow-up

Our patient engagement and follow-up processes include:

• Patient statement services.  We generate and mail/print patient statements as per a compliant, planned cycle to ensure patients are communicated timely, and there is an ongoing revenue flow. Reminders are sent out within a defined period.  We work with our clients to ensure that billing statements are easy to read and comply with patient-friendly billing guidelines. 

• Self-pay follow-up. Our follow-up team evaluates and bills the patient for co-pay, deductible, or other patient responsibilities such as self-pay. We also address any support requests and queries from patients regarding their bills.

• Implement patient portals. We bring best-in-class partners who can implement patient portals and enable payment processing via the patient portal.

• Benefits of our self-pay and patient follow-up services

  • PCI-DSS compliant processes 

  • Omni-channel contact via email, inbound/outbound phone calls, chat (where possible), and mails. 

  • Secure payments processing over the phone

  • Defined collections model, compliant with state and federal regulations

Revenue Cycle Analytics

Our analytics services and solutions can be delivered using our proprietary technology or by implementing specific reports on the customer's revenue cycle platform. We work with the leaders of each functional area to create a suite of reports from the executive level to the operational leaders. Our dashboards are designed to provide intuitive insight into the trends and enable the performance of the root-cause analysis.

• A/R analytics. A/R and denials data are analyzed on multiple dimensions: days in AR, performance by facility or specialty, aging buckets, top reasons for denials, first-pass resolution rate, etc. 

• Denial analytics and underpayment review. Denial Analytics is provided by the payer and by issue to direct efforts on denied and underpayment accounts.

• Operational productivity benchmarks. For all our processes, our workflow provides insights into the productivity and performance of agents. The transactional measurement is critical as it allows for functional productivity views, leading to revenue cycle success. 

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