Product Spotlight: Denials Management

By Chip Means | February 6, 2009 | 9:31 AM

Claims management tracking gets more complicated, personal

Claims management systems are increasingly occupying an integrated space between provider and payer, according to Carl Doty, senior analyst in healthcare and life sciences for Forrester Research. The claims "clearinghouses" that are typically bundled administrative applications will need to offer financial and clinical sides to their solutions to remain viable in today's market. "(These platforms) don't add a lot of value to the payers, so they're trying to find all kinds of ways to add value to the customers. There's a lot of investment going into clinical connectivity and financial connectivity," said Doty. Denials management solutions are starting to offer more provider-facing reporting mechanisms, said Doty. "Some of these solutions are giving their providers the ability to go in and track denials rates with recent codes. Providers can track who among their staff has the highest denials rate."

Alpha II's RevenueQueue automates the tedious task of auditing claim remittances.
3 TRENDS TO WATCH
Carl Doty, senior analyst in healthcare and life sciences at Forrester Research, sees the following claims management trends on the horizon:

1. REPORTING: Vendors are increasingly offering provider-facing analytics reporting, allowing customers to look at the rates of denials broken down by individual providers.

2. REAL-TIME UPDATING: With increased uptake of consumer-directed health plans, vendors will need to be able to ramp up their real-time transaction capabilities.

3. INTEGRATION: Clearinghouse platforms that don’t offer integration with clinical and financial transactions are at the highest risk in the claims management field.

Vendor Showcase

ALPHA II
RevenueQueue
Alpha II’s RevenueQueue automates the tedious task of auditing claim remittances, turning explanation-of-benefits data into business intelligence and discovering missing revenues for both small and large healthcare organizations. As a collaborative, denial management workflow tool, RevenueQueue helps users prioritize tasks-by payer, volume or dollar value, for example-for greatest impact.
Contact: Alpha II, 800-476-8477, info@alphaii.com

CAREMEDIC SYSTEMS
Denial Recovery Services
Denial Recovery Services combines configurable technology with technology-enabled services to identify, track, manage and recover denied claims. The performance-based solution combines the capabilities of CareMedic’s electronic Financial Record™ (eFR®) system with expert services staff to fully manage the process of identifying the root cause of denied claims and then accelerate rebilling, appeals and cash recoveries. Users have an option for short- or long-term staffing assistance to bring denied claims processing up to date and move forward within an improved framework.
Contact: Jose Miranda, Sales Analyst, 800-508-8494, products@caremedic.com

ECLIPSYS
Sunrise Patient Financials
Sunrise Patient Financials is a comprehensive revenue cycle management solution that spans the entire revenue cycle process, including scheduling, registration, clinical care and billing processes. By integrating financial and clinical operations, this solution helps healthcare organizations reduce costs associated with unauthorized services and mismanaged resources and improvereimbursement.
Contact: Brad Tinnermon, (404) 847-5224, Bradley.Tinnermon@Eclipsys.com

EMDEON
Emdeon Denial Manager
Emdeon Denial Manager allows providers to organize and manage remittance inventory; helps staff arrange, prioritize and monitor denials and underpayments; and allows the accurate reporting and viewing of the denied and adjusted amounts. With the information produced by Emdeon Denial Manager, providers streamline the denial management process by determining root causes, patterns and process breakdowns responsible for denials, and establishing corrective steps to prevent future revenue loss or delay.
Contact: 877.363.3666, instsales@emdeon.com

MEDSYNERGIES, INC.
MedSynergies Denials Management
Assisting healthcare organization to better understand claim rejections, MedSynergies analyzes claim denials based on six thousand codes and categorizes each into a sub-subgroup to reduce future denials, improve efficiency and, ultimately, maximize the revenue cycle process.
Contact: Clayton Harbeck, (888) 275–9410, info@medsynergies.com

MRO
RAC Tracker Online
MRO’s RAC Tracker Online is a request management program that enables hospitals to effectively manage the Recovery Audit Contractor (RAC) audit process. The module allows healthcare providers to manage incoming RAC requests from initial audit through the appeals process and payment resolution. In addition to tracking all aspects of the process, RAC Tracker Online creates detailed trend analyses, identifying steps that will allow providers to enhance the claims process and avoid future audits.
Contact: John Walton, 888-252-4146 x305, johnwalton@mrocorp.com

NAVICURE
Navicure Claims Management
Serving thousands of physicians in practices nationwide, Navicure’s award-winning Web-based account receivables management solutions automate receivables processes, including patient eligibility verification; primary and secondary claims reimbursement; rejected and denied claims management; electronic remittance posting; claims and remittance reporting and analysis; and patient statement processing.
Contact: Matthew Halkos, 877-280-3334, sales@navicure.com

NEXTGEN HEALTHCARE INFORMATION SYSTEMS
NextGen Enterprise Practice Management (EPM)
NextGen EPM “scrubs” all claims – searching for errors or missing information and applying the required edits – to help prevent denials.
Contact: 215-657-7010, sales@nextgen.com

User Reviews

"Navicure gives us the ability to promptly identify errors, get them corrected and resubmitted, which has had a positive impact on our average days in A/R."
Rebecca Dix, Account Manager for HuTech Resources, LLC
"NextGen EPM allows us to manage denials in a timely manner by setting up claim edits and tasks which hold users responsible."
Amy Green, A/R Manager for Olive Branch Family Medical Center