Denials and Appeals Management

Outsourced denials and appeals management services for hospitals that want to improve their clean-claims rate, better manage denied claims, and have expert assistance in handling appeals.

Minimize Medical Billing Denials

Identify and correct root causes of denials to improve your clean-claims rate.

Streamline workflows for greater efficiency, faster appeals, and improved cash flow.

Reduce your cost of managing denied claims and the administrative burden on staff.

Help reduce regulatory risk with improved compliance.

Rely on our expertise to resolve underpayments.

Help improve revenue cycle management and financial performance.

Improve Your Denial Management Workflow

Denials and appeals management services

  • Access our expertise in analyzing payer adjustment codes from remittance advice, including case management and utilization review, to facilitate successful appeal of denied claims.
  • Enable our skilled, experienced staff to advocate on your behalf with payers; we help to quickly resolve underpayments related to interpretations of contract, policy, or documentation.
  • Benefit from our custom-created ‘Gold Standard’ compliance program which exceeds all requirements of the Office of Inspector General.
  • Our clinical and technical experts include skilled nurses and revenue cycle experts, and because our services are system-agnostic, these staff can work onsite or remotely within your existing billing system and EHRs.

Payer audit services

  • Leverage our expertise in appealing Medicare notifications to rescind payments via the Medicare Recovery Audit Contract Program (RAC), and to address other commercial and government payer audits.
  • Rely on our team to coordinate medical chart reviews and meet appeals deadlines, alleviating the administrative drain on your staff in patient financial services, case management, and health information management.

Ongoing system edit-and-workflow maintenance

  • Depend on our experts to keep your team abreast of regulatory changes. We review and implement payer bulletins and educate your staff via tutorials—all to facilitate a proactive approach to denials management.
  • Engage our team to provide ongoing edits maintenance, workflow modifications, and system cleansing to help ensure your claims submissions reflect payer compliance updates and regulatory changes.

Detailed denials management process reporting

  • Gain valuable trending insights as well as specific recommendations for documentation, edit improvements, claims management, and process improvements to address the root causes of denials and to increase clean claims.
  • Leverage our detailed reports on denials and underpayments during payer contract negotiations.

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