Payment Recovery: Payment Recovery Optimization
Recover every dollar you’ve earned through structured A/R follow-up and patient collections.
- Aged A/R Segmentation: We categorize your outstanding receivables by payer, aging bucket, and balance, targeting the most recoverable claims first.
- Targeted Follow-Up Workflows: Specialized teams manage payer-specific follow-ups using denial codes, escalation protocols, and status tracking to resolve claims faster.
- Underpayment Analysis: We compare allowed vs. paid amounts against contracts, flag discrepancies, and recover underpaid claims through reprocessing and appeals.
- Patient Balance Recovery: Our team helps communicate transparently with patients, enabling collections through respectful engagement and flexible payment plans.
- Timely Appeal Submissions:Structured appeals with supporting documentation are submitted within deadlines to overturn denied claims and maximize collections.
Strategic Denial Management: Reduce preventable denials and build a smarter, more compliant RCM process.
- Denial Root-Cause Analysis: We track and report the top denial reasons (eligibility, prior auth, coding errors), and implement permanent fixes.
- Payer-Specific Denial Patterns: Insights into frequent denial behaviors by payers help refine billing rules and renegotiate contracts where necessary.
- Preemptive Edits & Flags: Front-end edits and custom rules in the clearinghouse prevent known denial triggers before claims are submitted.
- Appeals Strategy & Tracking: Each denial is classified and routed to the appropriate appeal pathway with ongoing status monitoring and escalation when needed.
- Prevention Through Education: We provide denial education to front-desk, billing, and coding teams, creating upstream improvements across the revenue cycle.
Advanced Reporting: Make smarter decisions with real-time, specialty-focused analytics and KPIs.
- RCM Performance Dashboards: Visual dashboards track key metrics such as denial rate, DSO, net collections, and clean claim rate—all updated in real time.
- Custom Reports by Specialty: Whether you’re a hospital, ASC, or specialty clinic, reports are customized to track what matters most for your operations.
- Drill-Down Data Views: Zoom into claim-level, payer-level, or provider-level performance to identify revenue leaks or operational inefficiencies.
- Alerts & Exception Reporting: Receive alerts for missed billing timelines, underpayments, and trends that need attention, enabling faster response and correction.
- Client-Facing Transparency: All reporting is available to clients on-demand, ensuring full visibility and trust in your revenue cycle operations.
Predictive Revenue Forecasting: Plan for growth, mitigate risks, and allocate resources more strategically.
- Revenue Trend Projections: We use historical and current data to project future revenue, giving your leadership better financial foresight.
- A/R Cash Flow Modeling: Forecast expected recoveries across A/R aging buckets to support stable cash flow planning.
- Denial Volume Forecasting: Anticipate spikes in denial trends by season, payer, or specialty to strengthen front-end mitigation strategies.
- Business Intelligence for Expansion: Use insights to evaluate potential service line additions, location expansion, or provider performance optimization.
- Scenario-Based Planning: Plan for “what-if” scenarios like payer changes, policy updates, or staffing shifts with smart forecasting tools.
Operational Performance & Compliance Analytics: Ensure your processes, people, and documentation meet the highest standards.
- Staff Productivity Tracking: Measure billers’, coders’, and follow-up agents’ output by volume, speed, and success rate to optimize performance.
- Workflow Bottleneck Analysis: Identify operational slowdowns (e.g., in prior auth or charge entry) and redesign workflows for better throughput.
- Audit-Ready Documentation: Maintain clean audit trails with consistent tracking of payer communications, appeal actions, and claim history.
- KPI Benchmarking: Compare your performance against industry and specialty benchmarks to identify improvement areas and competitive advantage.
- Regulatory Compliance Checks: Ensure ongoing compliance with CMS, HIPAA, and payer policies through documentation audits and automated alerts.