Claims Management

Claims Management is the facility's internal workflow for preparing, submitting, and collecting claims. The claims management process begins during admissions when staff collect the necessary patient and health insurance information. The process ends only when the facility has receives the appropriate payment for the services rendered

  • Are your claims over 90 days greater than 20%?
  • Do you have a strategy to minimize the number of touches on claims for follow up?
  • Do you have a strategy to insure largest dollars are worked on first and frequently?
  • Do you have a defined work flow driven by technology?

Claims Management

Assuming that sound processes are observed through Admissions, Registration, Eligibility, Charge Capture, Coding, and Billing; this stage of the Revenue Cycle should ensure that staff observe best practices for claim processing, adjudication, and payment.

Best Practices

As in any process, setting measurable objectives is an important first step; following up on the progress toward attaining your objectives, is critical to short and long term success.

  • Cash collection goal of 100% of 60 day lag NPSR
  • Accounts receivable greater than 90 days should be maintained at <20% of NPSR
  • Bad debt should be <8% of gross revenue
  • Credit Balances should be maintained at less one day of revenue

Services

re|assess

Revenue Cycle Assessment

The revenue cycle challenges faced by hospitals today are enormous. Charge Capture, Coding, reimbursement and compliance issues plague larger facilities as well as rural and community hospitals. Resources to ensure appropriate reimbursement for services provided are stretched. re|assessre|solution’s revenue cycle assessment provides the foundation to optimize your revenue cycle and performance. <more>

re|source

Interim Staffing

Hospitals are constantly struggling with retaining qualified personnel (particularly with smaller community hospitals).  Replacing key personnel in the business office may require training existing personnel and establishing procedures and policies that enhance a new manager’s ability to perform.  Occasionally, locating a new employee takes time to find a good fit.  The facility may not have the luxury of reduced cash flow while recruiting takes place.  re|solution has qualified and experienced personnel ready on a moment’s notice to assist as Business Office Managers, Coders, Billers, Collectors and Cash Posters.  Business office interim staff are placed on-site for as long as they are needed. <more>

re|store

Insource Your Business Office

The regulatory atmosphere and relentless pressure of increasing complexity combine to create staggering challenges while introducing risk to your facility's ability to get paid for the services you are expected to deliver to the community.

  • Increased federal and state regulatory, oversight, and audit pressure continues to drain resources and cash from hospitals while these same agencies increase their focus on billing and coding compliance, often issuing stiff penalties
  • Reductions in reimbursement, increasing self-pay or higher deductibles combine to make cash collection critical
  • Revenue and cash collection are increasingly put at risk due to inadequately trained staff, the inability to afford the best technology and tools, and the struggle to implement and maintain best revenue cycle practices

Your facility has a significant investment in a billing system but does not have the personnel available to adequately manage and staff the business office under this ever-changing environment . re|solution performs all business office functions using your facility's existing billing software and utilizing a mix of your staff, our experienced personnel on-site and from one of our regional billing centers. This treatment is most effective in managing business office costs and relieving billing headaches, without the added expense of replacing your existing system. <more>

re|wind

System Conversion A/R Wind Down

Your new system conversion date is nearly here. You and your leadership team and staff have dedicated a large amount of time to implementation, planning and training while at the same time trying to maintain current operations. System implementations are complex and at times can be overwhelming, and despite your best efforts, key performance indicators can begin to move in the wrong direction. <more>

Benchmark

How does your facility compare nationally with other facilities of your respective size?

re|solution is an expert in rural, community, and critical access hospitals, providing superior accounts receivable management, revenue cycle analysis, training, charge capture reviews, interim staffing, and an array of other business office services.  If you are interested in knowing how the performance of your business office compares with demographically similar facilities and where your opportunities exist to increase CASH. Please complete the form below and return it to us by fax or e-mail.  In return, we will provide you with a free benchmarking analysis.  We will also make ourselves available for a discussion and explanation of the data. You may view a Sample Report.

Benchmark Indicator Analysis

Please click to complete the Benchmark Indicator Analysis online and we will return your results to you shortly. Your information is confidential.

If you prefer you may print and complete the form and Fax to (303) 847-0417 or e-mail to analysis@ereso.com.

Case Studies

Towner County Medical Center Increases Cash by Over 30% in First Year of Insource

TCMC’s leadership collaborated with re|solution using an Engagement Management Action Plan for an efficient insource transition. The plan outlined a variety of milestones and goals designed to optimize revenue cycle operations. TCMC employees were transitioned to re|solution, retaining jobs in the community.

Dallam-Harley Counties Hospital District increases cash and reduces expenses

In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals.

Ohio Valley Medical Center and East Ohio Regional Hospital find over $16 million in Net Revenue

Ohio Valley Medical Center deployed re|assess™ complemented by an experienced re|solution BOD to assess staff and staffing levels, provide training and accountability. The re|solution proprietary tools were utilized and left behind for sustainable improvement and success.

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