Our Process (AIMS)
Advicare Information Management System
No Stone Unturned
In the pursuit of recovering revenue from your denied clinical claims, the Advicare team leaves no stone unturned…literally. That’s because our team utilizes proprietary technology that guarantees we explore every avenue, every opportunity, every angle, and every chance to substantiate the accuracy of your claims.
We call it AIMS: Advicare Information Management System.
Prevent Denials, Provide Documentation Opportunities
AIMS exhaustively guides our denial resolution specialists through a step-by-step investigation of each case to uncover any variable that can support overturning a claim previously denied for clinical reasons.
Moreover, AIMS allows our clinical and legal experts to identify the root cause of clinical denials, and thereby implement prevention processes that move your organization towards fewer denied claims.
Using All Available Data
It may be difficult to extract data from your EMR to allow for easy analysis, particularly in reference to one clinical denial. Your team needs access to everything, including specific actions taken by medical and administrative staff along the lifespan of the claim.
Even if that information were easy to access, your clinical team’s time is better focused on patient care, and your revenue cycle team’s time is better spent focusing on easier functions with a higher return.
Leave It To Us
Clinical denials are multi-faceted, and EMRs don’t highlight the clinical decision-making factors that led to a denial. From insufficient documentation, to missing medical explanation, the data gathered in AIMS allows our team to identify the actual cause of a denial by examining every component of the case, including:
Was the necessary documentation provided?
Was a peer-to-peer review performed and the results included with the claim?
What criteria did the payer use to approve or deny the service?
Was the denial related to proper criteria for inpatient vs. observation level of care?
Were proper timing guidelines followed for an inpatient admission?
Did the bill type match the physician order?
Improve Your Operational Efficiency
AIMS is a highly targeted tool that can improve internal processes and identify opportunities for additional documentation. It can be used on denial issues such as Length of Stay, DRG Validation, OP Claim Denials, and IP Level of Care – any or all of them, as our clients require.
Whether you’re an existing client looking to expand your relationship or a new potential partner, we would like to speak to you and learn more about your needs. Contact us today.