Middle
Find and address the root causes of revenue leakage
Many aspects of the mid revenue cycle — coding; charge description master (CDM) maintenance; charge capture; and clinical documentation — can contribute to revenue leakage, leading to:
- Less net revenue collected
- More medical necessity payer denials and underpayments
- Decrease in case mix index (CMI)
- More manual claim cleanups and edits and an increased cost to collect
These case studies highlight the real-world success some of our customers have achieved.
West Tennessee Healthcare > Mid-Atlantic client >Mid revenue cycle challenges can take significant time and money to reprocess or appeal. We can help. Our mid revenue cycle solutions include:
- Coder training and education
- Coding quality, documentation, and policy assessment
- Payer coding audits
- Interim HIM and/or coding management
- Evaluation and management (E/M) coding audits
- Charge capture audits
- Denial and appeal management, leveraging machine learning algorithms
- Inpatient/outpatient coding guideline development
- Clinical documentation improvement (CDI)
- Charge description master (CDM) review and maintenance
The art and science of clinical denials management
Our intelligent denial management solutions — a strategic blend of art and science — can help you reduce costs, cut process times, support patients, and strengthen cash flows.
The science: machine learning algorithms
We apply robotic processing automation (RPA), AI, and machine learning algorithms to denied claims to analyze vast denial data and group cases by attributes such as technical-vs-clinical, remit codes, denial reason codes, and responsible payor. Our system then sorts and assigns accounts to representatives who specialize in the various denial reasons.
The art: human expertise
Timely, accurate clinical appeal submissions are critical to ensuring the best outcomes. This is where we apply our most powerful asset: our people. Our appeal nurses average 25 years of experience in Recovery Audit Contractor (RAC) audits; CMS regulations and appeals; auditing processes for all major health plans; InterQual and MCG (Milliman) guidelines; and clinical documentation … all of which they apply to write custom appeal letters that stand the best chance for positive resolution, for you and your patients.