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Finally... a complete service for Denial Management |
"Most health systems lose between 3% and 5% of net revenues as a result of payment denial... CEOs have a 3% opportunity to improve their revenues." Modern Healthcare, Nov. 2002
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The HRG Solution: Let us handle all of your denials. Just send us your electronic remittance advice (835 format) and HRG will assume responsibility for appealing all your denials. |
The Denial Challenge... a growing concern • Increasing denials in all types of insurance • Limited time to appeal (as little as 30 days) • Constantly changing payer rules • Limited staff to dedicate to the issue • No automation to handle the high volume | ||||||
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Your Complete Revenue Cycle and Cash Enhancement Partner 800-695-8171 |
• Insufficient information to quantify the scope of the problem We're here for you!
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Denial Management - a complex problem Denials fall into three categories: coverage denials, authorization denials and medical necessity denials The sources of denials: • Verification errors • Authorization errors • Documentation errors and billing errors Types of denials: 1) Payer not notified of admissions 2) Coverage/benefits not verified 3) Patient status incorrectly assigned 4) Diagnosis/procedure code conflict 5) UR clinicals not given to payor 6) Inadequate clinical documentation 7) Admission or continued stay not authorized 8) Delay in testing procedure 9) Delay in discharge 10) Other In order to appeal and reverse a denial, additional information must be gathered. The source of this information can be the patient, the guarantor, the employer, the payer, the physician, the admitting department, the case management department, medical records, or any one of the multiple departments that may have been involved in the service provided for the patient. |
HRG takes on the responsibility of gathering the necessary documentation and preparing the appeal. Once the appeal is submitted, HRG follows through to insure the facility receives the additional funds that are due. Tracking and Reporting HRG will maintain a database of all denials received by the hospital and provide a range of monthly reports. Reports will show volume and types of denials by payer. Denials that cannot be appealed will be segregated from denials that can be appealed. Feedback HRG will analyze denials and make specific recommendations for reducing or eliminating denials. Benefits HRG provides the system. HRG provides the staffing. HRG provides the experience and expertise. Results More cash to you - FASTER. No staffing worries. No hiring or training problems. |
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©2008
Healthcare Resource Group, Inc. |
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