HEALTHCARE SERVICES DIVISION
TBS is a Strategic Advisory and Operations
Consulting Firm, providing outsourcing solutions
to our clients with quick scal...
Underpayment Recovery Services
• We audit your past 12 months zero
balance accounts to identify under
paid claims.
• After...
Underpayment Recovery Services - Overview
Reasons for Underpayment
* Contractual misinterpretations & payments
* Fee-sched...
Underpayment Recovery – Process Flow
DATA EXTRACT OF
PAID CLAIMS
DATA MINING ANALYSTS REVIEW
UNDERPAYMENT
IDENTIFICATION
U...
Underpayment Recovery Areas
A ‘360 Degree review ‘ approach is adopted to identify underpayments from a billing, coding &
...
Key Differentiators
 A decade of proven service track record
 End-to-end expertise on Payer and Provider domains
 Exper...
Value Proposition
Value
Proposition
Revenue enhancements &
cost optimization
Improve collections by up to 5% through
our R...
Payment Integrity Audit – Case Study
The client is a multi-site community healthcare system located in New York
 Successf...
Redefining Business Approach
Building Relationships
Learning Together
Knowledge Management
Process Improvements
Productivi...
Building Relationships
Learning Together
Knowledge Management
Contact me today to find out how TBS and
our solutions can i...
Prochain SlideShare
Chargement dans…5
×

Transnational underpayment recovery services-jm

146 vues

Publié le

Healthcare Underpayment Recovery Services

Publié dans : Santé
  • Soyez le premier à commenter

  • Soyez le premier à aimer ceci

Transnational underpayment recovery services-jm

  1. 1. HEALTHCARE SERVICES DIVISION
  2. 2. TBS is a Strategic Advisory and Operations Consulting Firm, providing outsourcing solutions to our clients with quick scalability and delivery capability, having a committed and very talented team of professionals. Within our Healthcare Division we help our clients by providing them with solutions that will improve their business processes so they can concentrate on providing better healthcare services. We have a history of client retention with successive years of contract renewals. OUR HEALTH CARE SERVICES INCLUDE: • Revenue Cycle Management • Compliance and Healthcare Content Management • Healthcare Process Improvement Consulting • Secure Healthcare Communications • Clinical Trial Management Solutions TBS Healthcare Services We want to earn your trust so we suggest beginning with our…..
  3. 3. Underpayment Recovery Services • We audit your past 12 months zero balance accounts to identify under paid claims. • After validation has been completed underpaid claims are resubmitted for payment. • You only pay us a percentage of the recovery once the collection process has been completed You collect additional revenues with nothing to lose!!
  4. 4. Underpayment Recovery Services - Overview Reasons for Underpayment * Contractual misinterpretations & payments * Fee-schedule changes * Miscalculation/Errors in risk-payment reconciliations * Inappropriate denials or down-coding of claims, * Non-payments. Our Approach * Partner with the Hospital to understand the claim billing & payment methodology, * Retrospective verification of payment accuracy and recovery of lost revenue * Analyze the paid claims considering multiple processing steps and various claim payment scenarios Solution * Identify & recover underpayments, review closed claims & incorrect denials/rejections through efficient use of predictive analytics * Manual analysis of the Billing/Coding practices & patterns to ensure that the billing processes are appropriate. Results * Detect the claims payment errors leading to underpayments and classify the suspected underpayments for recovery * Recovery of revenue from inaccurately paid contracts * Identification and correction of contract management issues, providing critical insights into the complex payer contracts.
  5. 5. Underpayment Recovery – Process Flow DATA EXTRACT OF PAID CLAIMS DATA MINING ANALYSTS REVIEW UNDERPAYMENT IDENTIFICATION UNDERPAYMENT VALIDATION BY CLIENT** CLAIM REFILING / PROVIDER APPEAL UNDERPAYMENT RECOVERY **Clients have the option of conducting a second level review of the underpayments identified, prior to initiating recovery efforts
  6. 6. Underpayment Recovery Areas A ‘360 Degree review ‘ approach is adopted to identify underpayments from a billing, coding & reimbursement perspective Billing Issues 40.55% Coding Issues 13.64% Denied as Duplicate 12.10% Contractual Updates 10.52% APG Reimbursements 10.25% APR DRG Reimbursements 7.96% Freqency limits Exceeded 4.16% Denied for TFL 0.81% * Sample underpayments for an existing client
  7. 7. Key Differentiators  A decade of proven service track record  End-to-end expertise on Payer and Provider domains  Expertise spanning across the value chain ranging from low- end transaction services to high-end audit & analytical services  Thorough understanding of the claim life cycle, enabling us to understand the nuances of Claims Management  Experience & expertise in the niche segments of Code Review, DRG Audit & Payment Integrity Audit  Experienced staff comprising of certified analysts & Professional Medical doctors as DRG coders  Customer satisfaction through our ability to thoroughly understand the client business requirements and highly effective delivery capabilities  Recovered underpayments of over $6Mm in a period of 18 months for a leading hospital in New York  Revenue increase ranging from 5% to 8%, with improvements in collection days & FPCR  Achieved cost savings of over 40% for clients  Significant Improvement in TAT, Payment Realization & reduction of AR days for Providers Benefits to Clients
  8. 8. Value Proposition Value Proposition Revenue enhancements & cost optimization Improve collections by up to 5% through our RCM expertise Our services can be used independently, or as 2nd or 3rd pass vendor in the Audit sphere Experience in the Payment Integrity Audit services, recovering underpayments of Millions of Dollars Comprehensive domain expertise spanning the entire spectrum of Provider services PROCESS ENHANCEMENTS BUSINESS PROCESS OPTIMIZATION HIGH END NICHE SERVICES
  9. 9. Payment Integrity Audit – Case Study The client is a multi-site community healthcare system located in New York  Successful knowledge transfer / remote transition in 15 days  Identified $6 Mm in underpayments within the first 6 months, as part of the initial round of analysis.  Recovered underpayments of $6 Mm from the Government & Commercial insurance companies  Consistent recoveries averaging close to $300 K per month from outpatient claims  Improvement in billing accuracy, through the insights we developed  Implementation of the APR- DRG pricing methodology, leading to ambiguity in ascertaining the appropriate receivables  Changing reimbursement methodologies of Medicaid & Medicaid HMO due to the transition from traditional reimbursement to the APR DRG methodology  Limited success ratio in recovering the underpayments due to the age of the claims  Challenges in appealing the claims, as the client had a system transition  Offered an offshore delivery model with remote transition/knowledge transfer  Developed a data mining tool to analyze the claims data  Performed a retrospective review & verification of payment accuracy and recovery of lost revenue  Established contact with the Provider Relationship Officers at the top insurers, to coordinate & expedite the processing of the Appeals  Coding & Billing analysis to provide insights into coding practices resulting in lower reimbursement Challenges ResultsSolution
  10. 10. Redefining Business Approach Building Relationships Learning Together Knowledge Management Process Improvements Productivity Gain Performance and Profitability Organizational Fit Openness and Accountability Ownership and Responsibility BEST POSSIBLE OPTION
  11. 11. Building Relationships Learning Together Knowledge Management Contact me today to find out how TBS and our solutions can improve your bottom line with no upfront costs to the Hospital! John Morrone Regional Sales Director Transnational Business Solutions, LLC 45 West 34th Street Suite 1107 New York, NY 10001 321-292-4746 jmorrone@transbizsolution.com

×