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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
67%of all denials are recoverable
90%of all denials can be prevented

Source: H*Works: The Advistory Board Company
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
  • Insufficient information to quantify the scope of the problem
We're here for you!

Your Complete Revenue Cycle and Cash Enhancement Partner

800-695-8171
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:
  • Payer not notified of admissions
  • Coverage/benefits not verified
  • Patient status incorrectly assigned
  • Diagnosis/procedure code conflict
  • UR clinicals not given to payor
  • Inadequate clinical documentation
  • Admission or continued stay not authorized
  • Delay in testing procedure
  • Delay in discharge
  • 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.
 
©2008 Healthcare Resource Group, Inc.

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