Date post: | 14-Aug-2015 |
Category: |
Healthcare |
Upload: | transbiz |
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TBS is a Strategic Advisory and Operations Consulting Firm, providing outsourcing solutions to our clients with quick scalability and delivery capability, having a committed and very talented team of professionals.
Within our Healthcare Division we help our clients by providing them with solutions that will improve their business processes so they can concentrate on providing better healthcare services. We have a history of client retention with successive years of contract renewals.
OUR HEALTH CARE SERVICES INCLUDE:
• Revenue Cycle Management• Compliance and Healthcare Content Management• Healthcare Process Improvement Consulting• Secure Healthcare Communications• Clinical Trial Management Solutions
TBS Healthcare Services
We want to earn your trust so we suggest beginning with our…..
Underpayment Recovery
Services • We audit your past 12 months zero balance accounts to identify under paid claims.
• After validation has been completed underpaid claims are resubmitted for payment.
• You only pay us a percentage of the recovery once the collection process has been completed
You collect additional revenues with nothing to lose!!
Underpayment Recovery Services - Overview
Reasons for Underpayment* Contractual misinterpretations & payments
* Fee-schedule changes
* Miscalculation/Errors in risk-payment reconciliations
* Inappropriate denials or down-coding of claims,
* Non-payments.
Our Approach* Partner with the Hospital to understand the claim billing & payment methodology,
* Retrospective verification of payment accuracy and recovery of lost revenue
* Analyze the paid claims considering multiple processing steps and various claim payment scenarios
Solution* Identify & recover underpayments, review closed claims & incorrect denials/rejections through efficient use of predictive analytics
* Manual analysis of the Billing/Coding practices & patterns to ensure that the billing processes are appropriate.
Results* Detect the claims payment errors leading to underpayments and classify the suspected underpayments for recovery
* Recovery of revenue from inaccurately paid contracts
* Identification and correction of contract management issues, providing critical insights into the complex payer contracts.
Underpayment Recovery – Process Flow
DATA EXTRACT OF PAID CLAIMS DATA MINING ANALYSTS
REVIEW
UNDERPAYMENT IDENTIFICATION
UNDERPAYMENT VALIDATION BY
CLIENT**
CLAIM REFILING / PROVIDER
APPEAL
UNDERPAYMENT RECOVERY
**Clients have the option of conducting a second level review of the underpayments identified, prior to initiating recovery efforts
Underpayment Recovery Areas
A ‘360 Degree review ‘ approach is adopted to identify underpayments from a billing, coding & reimbursement perspective
Billing Issues 40.55%
Coding Issues 13.64%
Denied as Duplicate
12.10%
Contractual Updates 10.52%
APG Reim-bursements
10.25%
APR DRG Reim-
bursements 7.96%
Freqency limits Exceeded 4.16% Denied for TFL
0.81%
* Sample underpayments for an existing client
Key Differentiators A decade of proven service track record
End-to-end expertise on Payer and Provider domains
Expertise spanning across the value chain ranging from low-end transaction services to high-end audit & analytical services
Thorough understanding of the claim life cycle, enabling us to understand the nuances of Claims Management
Experience & expertise in the niche segments of Code Review, DRG Audit & Payment Integrity Audit
Experienced staff comprising of certified analysts & Professional Medical doctors as DRG coders
Customer satisfaction through our ability to thoroughly understand the client business requirements and highly effective delivery capabilities
Recovered underpayments of over $6Mm in a period of 18 months for a leading hospital in New York
Revenue increase ranging from 5% to 8%, with improvements in collection days & FPCR
Achieved cost savings of over 40% for clients
Significant Improvement in TAT, Payment Realization & reduction of AR days for Providers
Benefits to Clients
Value Proposition
Value Propositio
nRevenue enhancements &
cost optimization
Improve collections by up to 5% through our RCM expertise
Our services can be used independently, or as 2nd or 3rd pass vendor in the Audit sphere
Experience in the Payment Integrity Audit services, recovering underpayments of Millions of Dollars
Comprehensive domain expertise spanning the entire spectrum of Provider services
PROCESS ENHANCEME
NTS
BUSINESS PROCESS
OPTIMIZATION
HIGH END NICHE
SERVICES
Payment Integrity Audit – Case Study
The client is a multi-site community healthcare system located in New York
Successful knowledge transfer / remote transition in 15 days
Identified $6 Mm in underpayments within the first 6 months, as part of the initial round of analysis.
Recovered underpayments of $6 Mm from the Government & Commercial insurance companies
Consistent recoveries averaging close to $300 K per month from outpatient claims
Improvement in billing accuracy, through the insights we developed
Implementation of the APR-DRG pricing methodology, leading to ambiguity in ascertaining the appropriate receivables
Changing reimbursement methodologies of Medicaid & Medicaid HMO due to the transition from traditional reimbursement to the APR DRG methodology
Limited success ratio in recovering the underpayments due to the age of the claims
Challenges in appealing the claims, as the client had a system transition
Offered an offshore delivery model with remote transition/knowledge transfer
Developed a data mining tool to analyze the claims data
Performed a retrospective review & verification of payment accuracy and recovery of lost revenue
Established contact with the Provider Relationship Officers at the top insurers, to coordinate & expedite the processing of the Appeals
Coding & Billing analysis to provide insights into coding practices resulting in lower reimbursement
Challenges ResultsSolution
Redefining Business Approach
Building RelationshipsLearning TogetherKnowledge Management
Process ImprovementsProductivity GainPerformance and Profitability
Organizational FitOpenness and AccountabilityOwnership and Responsibility
BEST
POSSIBLE
OPTION
Building RelationshipsLearning TogetherKnowledge Management
Contact me today to find out how TBS and our solutions can improve your bottom line with no upfront costs to the Hospital!
Paul Szklarski, FACHEConsulting PartnerTransnational Business Solutions, LLC45 West 34th Street Suite 1107New York, NY [email protected]