1. a Beverly Brouse Creation
Initiatives
• Cash Collection Enhancement
• Front-end, Back-end & Indigent/Uninsured
• Revenue Cycle Enhancement
• Process Improvements Identified through Denial Trends
• Charge Capture
2. a Beverly Brouse Creation
Cash Collections Enhancement
• Cash Flow Analyses (Provide training, guidance or solutions)
• Front-end
» Facilitate collection of co-pays for scheduled, elective &
emergent procedures
• Back-end
» Facilitate productivity monitoring & tracking
» Facilitate worklist maintenance & collection efficiency
» Perform third party payor A/R recovery
» Perform third party payor credit balance clean-up
• Indigent/Uninsured Patients
» Facilitate up-front eligibility screening
» Facilitate financial counseling
3. a Beverly Brouse Creation
Revenue Cycle Enhancement
• Denial Based Analyses (Provide training, guidance or solutions)
• Identify third party payor denial trends
• Identify root cause of denial
» Document current procedure flow
» Identify process improvements
» Provide remedial action plan
» Perform further analysis, when necessary (interviews/researching policies
and procedures)
• Facilitate action plan
• Charge Capture Analyses
• Perform charge flow verification
» Service > Superbill/Ticket > Charge/Billing system > CDM > UB
4. Third Party Payor A/R Recovery
a Beverly Brouse Creation
Tools Utilized
• Tracking database (for logging all activity)
• Available on-line payor assistance programs
(for checking claim status)
• Ohio Prompt Pay Guidelines
• Action checklist (for performance guidance)
5. Third Party Payor A/R Recovery
a Beverly Brouse Creation
Required Access to…
• Aged trial balance
• Commercial payor contracts
• Health Information System
• Medical Information System (i.e. ChartMaxx)
• Explanation of Benefits (for 2ndary payor balances)
• Phone & listing of payor contact information
6. Third Party Payor A/R Recovery
a Beverly Brouse Creation
Action Checklist
• Work claims in priority of high dollar & age
• Group claims by payor for maximum efficiency
• Review account history & determine required
action (i.e. contact payor, CSA correction, provide additional
information, request for rebill…)
• Perform action
• Document action taken & anticipated result
• Revisit account once a week until resolved
7. Third Party Payor A/R Recovery
a Beverly Brouse Creation
Maximize Hospital Recovery
• Data shows that the likelihood of collecting reimbursement
decreases significantly with every passing day. Our
services focus on the collection and clean-up of these aged
third party payor receivables.
• Often times, aged receivables go un-worked due to the
constant submission of new claims, equipment restrictions,
staff limitations, or productivity inefficiencies. With our
services, we will assist in the reduction of aging A/R,
increase cash flow, identify billing, payment and posting
trends, and provide continuous feedback on an ongoing
basis.
8. a Beverly Brouse Creation
Third Party Payor Credit
Clean-Up
Tools Utilized
• Tracking Database
• Balance Determination Template
Required Access to…
• Commercial Payor Contracts
• Health Information System
• Explanation of Benefits
9. a Beverly Brouse Creation
Revenue Cycle Enhancement
Tools Utilized
• Interviewing Questionnaires
• Microsoft Visio Flowcharting Software
10. a Beverly Brouse Creation
Revenue Cycle Enhancement
Required Access to…
• Policies and Procedures
• System Flows/Interfaces
• Denial Reports
• Error/Edit Reports
11. Revenue Cycle Enhancement
a Beverly Brouse Creation
Denial Analysis
Common Denials/Scenarios
• Pending Receipt
• Pending Additional Information
• Untimely Filing
• Medical Necessity Disputes
• Usual and Customary
• Non-Covered Service/Item
• Precertification/Preauthorization Disputes
• Policy Exclusions
• Beneficiary Number Not Found
• Contract Disputes
• Prompt Pay Violations
