03.Maximizing Model.05.17.10 1
1
10% 10% 40% 40% 10% GAINS 1 2 3 4 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 technological investment/efficiency Daily Patient Demographic Data Transmittal Reconciliation & Verification • Prevent missed claims • Prevent errors in claims Coding for Reimbursement • Don’t undervalue services • Documentation to support coding • Physician documentation education Denial Minimization • Claim resolution • Research, correct and resubmit claims Data Analytics • Data reporting • Predictive trending • Revenue Cycle Management Contract Negotiation • Analyze contracts • Negotiate favorable terms • Monitor contracts Claims Submission– Claims Paid or Denied Payment Posting– Accurate Payment Reconciliation Patient Statements As many as 4 sent General Office Processing–Verification & Reconciliation CODING COMPLIANCE AUDITS Electronic Claims,Scrubbing, Editing & Submissions Payments Electronic Deposits Follow-up & Resolution - Claims unpaid, Denied or Underpaid Collections– Delinquent Accounts MAXIMIZING REIMBURSEMENT The average practice misses 10% of every reimbursable dollar, how do you capture that revenue? Days VERIFICATION AUDITS REGULAR CODING STRATEGY/ANALYSIS CLAIM RESOLUTION AUDITS MAXIMIZE PATIENT PAYMENT CONTRACT VERIFICATION AUDITS Coding Abstraction, Review & Editing
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Transcript of 03.Maximizing Model.05.17.10 1
10% 10%40% 40%
10% GAINS
1 2 3 4 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
technological investment/efficiency
Da i l y Pa t i en t Demogr aph i c Da ta
Tr an smi t t a l
Reconciliation & Verification• Prevent missed claims• Prevent errors in claims
Coding for Reimbursement• Don’t undervalue services• Documentation to support coding• Physician documentation education
Denial Minimization• Claim resolution• Research, correct and resubmit claims
Data Analytics• Data reporting• Predictive trending• Revenue Cycle Management
Contract Negotiation• Analyze contracts• Negotiate favorable terms• Monitor contracts
C la ims Submi s s i on– Claims Paid or Denied
Pa ymen t Po s t i ng– A c cu r a t e Pa ymen t
Re conc i l i a t i on
Pa t i en t S t a t emen t sA s many a s 4 s en t
Gene r a l O f f i c e P r o ce s s i ng–Ve r i f i c a t i on
& Re con c i l i a t i on
CODING COMPLIANCE AUDITS
E l e c t r on i c C l a ims , S c rubb ing ,
Ed i t i ng & Submi s s i on s
Pa ymen t s E l e c t r on i c Depos i t s
Fo l l ow -up & Re so lu t i on - C l a ims unpa id , Den i ed
o r Unde rpa id
Co l l e c t i on s–De l i nquen t A c coun t s
MAXIMIZING REIMBURSEMENTThe average practice misses 10% of every reimbursable dollar, how do you capture that revenue?
Days
VERIFICATIONAUDITS
REGULAR CODING STRATEGY/ANALYSIS
CLAIM RESOLUTION AUDITS
MAXIMIZE PATIENT PAYMENT
CONTRACT VERIFICATION AUDITS
Cod ing A bs t r a c t i on , Rev i ew & Ed i t i ng
