The problem: The challenge of bundled payments and re-admission rates is increasing billing complexity and denials. Underpayment has become so commonplace it is assumed. Denial patterns have become increasingly impenetrable. ICD-10 is poised to usher in an entirely new class of billing mistakes. In this environment, Revenue Cycle Leaders are being judged by their ability to recover revenue and accelerate cash flow.
The traditional means of dealing with such new realities do not work. Throwing staff and spreadsheets at challenges like these is tried but not true. By the time you get the numbers, they are yesterday’s news. All this is occurring within a system that is all about the next claim. As a result, you’ve been forced to accept untenable levels of underpayment and denials as the cost of doing business.
Solution: We can use predictive analytics to predict where denials are likely to occur next and drive the operational change needed to reduce denial rates. We can provide you with specific areas of revenue-risk to focus efforts to correct the originating issue(s).