Experts in Health Plan Coverage and Hospital/Physician Operations.
- Complex and Outsourced Financial Clearance
- Healthcare Consulting & Process Improvement
- Denial Trending, Recovery and Prevention
- Payor Audit Defense
- Utilization Review & Management
- Interim Management
- Zero Balance Account Review
Key Service Lines
We are focused on revenue cycle excellence. Our services lines focus on
ensuring you’re paid timely and accurately by all third party payors.
& Process Improvement
Audit and Recovery
We work with payors to ensure that entire plan of care is authorized and confirmed as a covered benefit. Our proven innovative approach:
- Increases overall reimbursement
- Improves patient satisfaction
- Boosts patient volumes
- Reduces operational disruptions
- Eliminates administrative burden
- Provides clarity for patients and families
Healthcare Consulting & Process Improvement
Our seasoned professionals and highly skilled associates work collaboratively with your teams to design and implement the right solutions for your unique challenges and needs. We utilize our Lean Six Sigma certifications and experience to ensure we find and remediate the root cause of the problem.
- Revenue cycle assessments to identify inefficiencies, gaps, and risks
- Policies, procedures and process flow diagrams
- Updated workflows for new regulations or compliance
- IT implementation support and project management
- Staffing analysis and organizational realignment
- Quality assurance reporting and training development
Utilization Review & Management
Our seasoned professionals work collaboratively with your teams to design and implement the right solutions for your unique challenges and needs.
Staff Augmentation – Our experienced nurses provide initial and concurrent reviews in all care settings. They are proficient in evidence-based criteria platforms and up-to-date on the latest Medicare and Medicaid regulations.
Outsourced Concurrent Reviews – Our teams can fully manage your utilization review department to ensure optimal staffing ratios, operational policies, timely appeals, and regulatory compliance.
Specific Populations – Given responsibility for a specified population, our teams will conduct initial and concurrent reviews, appeal denials, and maintain regulatory compliance.
Audit & Recovery
Our technology-first approach identifies underpayments in zero-balance account populations that other solutions miss:
- Increased Recoveries
- Reduced Cost to Collect
- Timely Resolution
- Flexible Deployment
- Next-Generation Technology
- Proprietary Billing & Coding Audits
- Automated Approach
Maximize recoveries and minimize revenue loss.
- Customized solution to enhance your denials program
- Comprehensive denial trending to discover prevention strategies
- Flexible offerings implemented alone or in combination
- Lightweight implementation can deliver recoveries in less than 30 days
- Virtual extension of your business office
- Seamless integration with existing processes
- End-to-end services with underpayments managed through to recovery
- Contingency-based fee structures present no risk to you