Analysis of payer contracts and chargemaster to identify opportunities for improved compliance and consistency in billing structure with management of any corrections or rebills necessary.
Identification of incorrect coding and missing charges, and review for net revenue potential. Analytical insights influence process change to reduce or eliminate future occurrences.
CONTRACT MANAGEMENT & MODELING
Analysis of managed care and government payer contracts, and creation of scenarios modeling the revenue impact of changes to insurance contracts, charges, coding and pricing
HIM CODING REVIEW
Analysis of patient accounts and claims to determine proper use of CPT and HCPCS codes and DRGs.
TRANSFER DRG REVIEW
Evaluation of all transfer-eligible accounts to identify potential missing reimbursement and management of the rebilling process with Medicare to receive appropriate payment.
PAYMENT VARIANCE ANALYSIS
Identification of accounts that have been incorrectly reimbursed or denied, and management of the appeal process to gain correct payment.
Analysis of the chargemaster, payer contracts and market competitiveness to identify areas of pricing opportunity and to create pricing scenarios aligning with strategic goals.