Middle
Find and address the root causes of revenue leakage
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:
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:
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.
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.
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.