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solutions FOR HOSPITALS

Preventing Clinical Denials

What if you could completely avoid denied claims? We know that insurance companies are in the business of collecting premiums, not paying claims. There will always be denials, but Advicare can help by using data to assist providers in understanding and preventing denials.

 

Prevention Programs That Work

Our prevention programs cover a lot of ground, including creating a strategy, staying on top of denials, and developing clear reporting guidelines.

 

By having Advicare collaborate with your organization, you’re allowing our experts to take a “bird’s eye view” of your business, including the root cause for your denial prevention, the percentage of avoidable clinical denials, and how you address accountability in your organization.

 

We will help you build a Denial Avoidance Team to leverage your skills – along with ours – to drill down the root cause of denials and prevent them in the future.

 

Denial Prevention & Workflow Management

Sometimes, it’s not what you do, but how you do it. We can help you put systems in place for denial prevention. We will work with your team to augment your understanding of all payer requirements, from documentation and preauthorization to allowable claims and proper formatting. In addition, we will help you optimize your revenue cycle and determine all forms of avoidable clinical denials, including:

 

  • Lack of medical necessity

  • No authorization

  • Delayed discharge

  • Investigational procedure

  • Level of Care

At Advicare, we help your team track and measure all data, as well as sharing relevant data with other departments within your organization. We identify trends – with your help – to find areas where you can avoid denials, and where you can collect money faster.

 

Root-Cause Analysis

As your healthcare organization’s partner in overturning denied claims, Advicare will review thousands of claims submitted to payers on your behalf. While other companies will scan your data to uncover the surface cause of the issue, we go much deeper. As we review your information, we accrue data and use advanced analytics to identify commonalities among your denied claims.

We also expand root-cause analysis by finding opportunities through clinical documentation. We will examine your team’s approach to medical necessity cases, ensuring that your approach utilizes diagnostic evidence, photographs, and imaging studies in the best possible way.

In addition to examining your processes, we look for problems – as well as opportunities – presented by payers. From clinicians on the front line, to payers, to schedulers responsible for prior authorizations, we will uncover the root causes of claims denials and report them on a quarterly basis.