RETURN ON PATIENT DOLLARS is where all the money is for providers, according to Elizabeth Woodcock, a speaker, author and consultant. Insurance follow up on claims that are denied, however, is a huge pain point.
“There is wonderful software out there to automate the very manual processes in billing and receivables management,” she said.
New products have come into the marketplace within the last five years that go beyond practice management systems’ capabilities. Built-in algorithms in the software have allowed automation through the transactions code to the reason for denial code.
Still, automation cannot run through billing start to finish. Human interface is still needed to tease out various regulations. The beauty of the software, however, is that if used correctly, the workforce is transformed from keying clerks to analysts who know how to act upon the accounts.
Three Trends to Watch
Elizabeth Woodcock, a consultant at Woodcock & Associates, cites these top three trends in denials management:
1. PRESSURE: Regulatory pressure on payers with regard to denials will bring relief to providers. Expect to see continued pushback and settlements from providers.
2. MORE DENIALS: The economic reality is we’ll continue to see more denials from Medicare, Medicaid and the large commercial payers, especially where medical necessity judgment calls are concerned.
3. INVESTMENT: As we see more expensive, less-skilled people entering the healthcare labor force, expect physicians to invest in the key areas of clinical automation and billing and collections automation.
Vendor showcase
Accuro Healthcare Solutions
Accuro Denials Manager
Features: Allows analysis of denied claims, provides workflow solutions and offers comprehensive reporting to enhance cash flow and decrease accounts receivables.
Contact: Sales Support, 877.321.0500, solutions@accurohealth.com
AdvancedMD Software
AdvancedMD
The most widely used Web based medical billing software and practice management solution in the industry, AdvancedMD serves more than 8,000 providers nationwide and offers free unlimited live technical support, secure anytime/anywhere access via the Web, fully HIPPA compliant security and a 98 percent client retention rate.
Contact: Lane Peterson, 801.984.9532, lpeterson@advancedmd.com
Boston Software Systems
Boston WorkStation
A workflow automation and integration technology that provides an environment for on-demand process innovation and development. It allows healthcare organizations to automate common tasks, including revenue cycle projects, interactions with Web sites, integrating new applications, systems and devices, and electronically monitoring and managing user activity.
Contact: Thom Blackwell, product manager, 866.653.5105, thomb@bossoft.com
Eclipsys
Sunrise Patient Financials
Sunrise Patient Financials is a proven revenue cycle management solution that helps healthcare organizations improve cash flow, reduce costs and increase patient satisfaction. The solution helps organizations reduce claim denials and improve recoveries by collecting valuable denial information from payers automatically through 835 Electronic Remittance processing.
Contact: 404.847.5000, info@eclipsys.com
Emdeon Business Services
Emdeon Denial Manager
Emdeon Denial Manager enables providers to streamline the denial management process by determining root causes, patterns and process breakdowns responsible for denials and establish corrective steps to prevent future revenue loss or delay.
Contact: Emdeon Business Services, Attn: Institutional Sales, 877.363.3666, InstSales@emdeon.com
Ingenix
Denial Management Tool Kit
Understand denials, manage the claims process, and learn what actions to take for a quicker turnaround time on reimbursement; from data collection and claims submission to payer inquiries and managing denials – submit correct information up front, know exactly how to correct denied claims and spend less time and money resubmitting.
Contact: Steven Woodward, product manager, 801.982.3225, steven.woodward@ingenix.com
McKesson Provider Technologies
Pathways Contract Management
Provides estimated patient out-of-pocket expenses for point-of service collections and automates the contracting and reimbursement process, including monitoring payments from payers, updating accounts receivable and performing what-if analyses across all payers to strengthen contract negotiations.
Contact: McKesson Provider Technologies Sales Inquiries, 800.981.8601
Meditech
Revenue Cycle
Meditech’s Denial Management Desktop, in the Billing/Accounts Receivable application, enables billing staff to efficiently manage and process denials through tracking, analysis and prevention tools. The Desktop features new routines enabling users to better manage denials. New and improved denial reports help meet all the needs of your Denial department.
Contact: Paul Berthiaume, 781.821.3000, pberthiaume@meditech.com
Navicure
Navicure Claims Management
Navicure provides physician practices with automated, Internet-based claims management solutions, including claims reimbursement, electronic remittance posting, secondary claims processing, advanced reporting and analysis, and ancillary services, such as patient statement processing, eligibility verification and data protection.
Contact: Matthew Halkos, 877.280.3334, sales@navicure.com
NaviMedix
NaviNet
An easy-to-use, free, Web-based solution that links providers with health plans and other sponsors by seamlessly integrating into the practice’s daily workflow enabling them to streamline clinical and administrative processes and get easy and secure access to the information they need to effectively engage with patients.
Contact: Alicia Allen, 617.715.6000, pr@navimedix.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: NextGen sales, 215.657.7010, sales@nextgen.com
Realmed Corp.
Realmed
RealMed is in the vanguard of a new era in healthcare administration that uses the power of the Internet to automate healthcare transactions and information exchange among providers, payers and patients. By connecting providers, payers and patients directly online, the advantages of real-time transaction capability can be brought to bear. This capability, together with more powerful reporting and workflow enhancing features can dramatically enhance administrative efficiency and time to payment performance levels for providers.
Contact: Colleen Wood, vice president of sales and service support, 919.622.4241
Siemens Medical Solutions
Soarian Financials
Soarian Financials goes beyond traditional patient management and patient accounting systems by embedding a contract engine, a claims engine, an enterprise-wide master person index (EMPI), patient access and denial management into a comprehensive enterprise revenue-cycle solution.
Contact: 888.826.9702, usa.med@siemens.com