ADDRESSING YOUR NEEDS
Tailored Solutions For Your Organization
While every hospital and health system is unique, we often see organizations struggling with clinical denials in excess of 5% of their total claims. We’re talking about millions of dollars of lost revenue.
Advicare specializes in overturning claims that are denied for medical or clinical reasons, and our results make a powerful, positive impact on the financial health of our clients’ organizations:
Our clients enjoy multi-million dollar increases in revenue.
Our clients write off fewer claims and show less bad debt on their balance sheets.
Our clients see favorable trends toward fewer denied claims based on implementation of prevention processes.
Our clients relieve their own clinicians from administrative burdens so they can focus on patient care.
Our clients use valuable staff time for core revenue cycle functions rather than appealing cases outside of their expertise.
Day-1 Clinical Denials
From the instant a payer denies a claim – from day-1 – the Advicare team jumps into action. With our Day-1 Clinical Denials program, we’re automatically notified of the denial. Our experts handle everything, alleviating your internal staff from the burden of detailed medical knowledge required to handle claims denied for clinical reasons.
The Day-1 program is our most popular because it results in the highest overturn rate, and, on a per-claim basis, this approach is most cost-effective.
“Safety Net” Denials
Let Advicare be your “safety net” for denied claims, for claims that remain unpaid for a specified amount of time, or for certain “tough as nails” payers your team doesn’t want to or can’t handle. With our Safety Net program, you can customize the scenarios that would trigger Advicare’s help; and in these circumstances, claims are automatically forwarded to Advicare for processing. Then, we take it from there.
You may already have a team in place to handle clinical denials, but sometimes you need extra help. That’s where we come in. With our Discretionary Denials program, you choose which claims to outsource to Advicare and which claims to handle using your own resources.
You’ll have the flexibility to assign denials from specific payers, for complex cases, or for whatever reason you choose. It’s at your discretion.
Work Queue Assistance
Clients who have developed effective internal teams to handle clinical denials rely on our Work Queue Assistance program on an as-needed basis to temporarily assist when staff members are unable to work. In addition, hospitals and health systems use our Work Queue Assistance service to augment their capacity when facing a large volume of clinical denials. When our clients’ teams are caught up – or a staff member comes back to work – Advicare can “return” the work queue.
Commercial and government payers frequently audit reimbursements for previously paid claims to examine the accuracy of their payments. With these post-payment audits, providers can “take back” what they perceive to be an overpayment.
Post-payment audits in the form of payer retractions and DRG downgrades disrupt your normal business processes, and represent a real threat to your organization’s income. Advicare is here to fight adverse decisions from post-payment audits and protect your earned revenue.
We go further. We go back to the “basics,” and look at your documentation of patient encounters to find errors and problem areas. We’re also a pipeline for changes in documentation requirements, so we can help you stay on track.
What to do with that mess of denied claims that sits and sits? You think you can get to it, but your team never seems to have the time. Let us clean it up. With Advicare’s Clean-Up Program we address those old, denied claims – oftentimes extracting significant revenue that might otherwise be completely lost. Moreover, your business office can focus on fresher, more collectible A/R.
Payment Policies And Payers
We can collaborate with your personnel to create a “smart” approach to modifiers, which includes monitoring payers and maintaining contact with payer representatives. We combine this with state-specific knowledge of payment rules, including timeframes.