In our February blog, we discussed how outsourcing gives hospitals access to IT services required to process claims more efficiently and accurately. In this blog, we look at how to evaluate the people and processes responsible for processing your complex claims when you partner with a third party.
Selecting a third party to process your complex claims is a huge decision that directly impacts your bottom line. At EnableComp, our goal is to be a trusted partner that delivers on our promises. That’s why we’ve created enterprise operating procedures that ensure we deliver stellar results from day one.
Your team of revenue cycle experts
Within days of formalizing a partnership, we begin the process of identifying and assigning an experienced team of revenue cycle experts to work your accounts. Even in cases where we need to add additional staff, our training, tech-enabled automation, and enhanced oversight processes ensure that your accounts are worked thoroughly and efficiently every single day.
- Training – Each team member initially undergoes 100+ hours of both online and hands-on training to ensure a thorough understanding of how to process every type of claim, with continual educational and professional development goals every quarter.
- Mentors – Team mentors share their experience with their colleagues all day long, answering questions and overseeing claims to ensure accurate and expedited filing.
- Resources – Teams are fully equipped with the latest IT tools in our proprietary software, Enforcer, so they can spend more time generating revenue and less time digging for answers.
- Experience – Our understanding of the differences between the payers enables us to work on accounts more effectively by knowing what is required. Our teams are assigned based on their payer expertise and knowledge, to ensure you get the best fit for your needs. One thing we’ve learned is “one size” never fits all in RCM!
How our enhanced processes accelerate cash flow
As soon as we receive your portfolio of accounts, we prioritize inventory based on hundreds of data points. Getting clean claims submitted to the correct payer with required authorization and documentation as quickly as possible is the key to quickly getting revenue back to your bottom line. Our focus is on processing bills correctly the first time to avoid denials on the back end. Our teams divide and conquer key areas of the RCM process specializing in moving claims through to successful recovery:
- Imports – New inventory is prioritized by our analytics group immediately, and the “plan of attack” for this batch of inventory is handed to the recovery team, who review and execute ensuring claims are validated and sent to payers quickly.
- Validation in Process – The payer or employer is being actively contacted to verify eligibility and proper COB.
- Submission in Process – Claims are being finalized, scrubbed, and documentation acquired in preparation for transmission electronically to payers to speed processing.
- Rebill Needed? – To ensure the bill is not already on file with the payer, the team conducts research to determine if/why the bill requires resubmission, correct the issue, and then resubmit to keep the account moving forward in the process.
- Variance & Denial Review – All claims not paid to expected reimbursement are analyzed in detail by our specialty Denials team: comprised of experienced billers, data scientists, nurse auditors, CPCs, and more. We pursue all variances owned and also identify the root cause of denials providing detailed and actionable education our clients can use to adjust internal processes.
As a best practices company focused on Veterans Administration, Workers’ Compensation, Motor Vehicle/TPL claims, and Complex Group Health & Government Denial Issues, our Revenue Services experts have the right expertise gleaned from constantly working with these classes/payers providing the most unique and complicated claims. We are proud to say we speak their language and have earned their respect and cooperation. By removing the complexity and payer challenges associated with these difficult claims, our clients rest easy knowing they are maximizing reimbursement and accurately submitting clean claims initially resulting in stellar outcomes!