Our Solutions: Account Receivables (AR) and Denial Management

 

Collections and Billing Follow-up:

As part of ESI’s BPO, all post bill production functions are handled by ESI. Utilizing a highly trained collection and follow-up staff in conjunction with ESI’s automated dialer technology, ESI will bring best-in-class healthcare follow-up and collection practices, and more importantly, results. ESI collection practices are firm, fair, and friendly with customer issues resolved within 24 hours or less. ESI has flexible cashiering functions with lock-box accounts for establishing payment capture and electronic funds transfers. Electronic files from the bank lock-boxes, as well as credit card payments, will be used to post payments and/or adjustments. All cash documents will be imaged for electronic storage and retrieval at the patient account level. All reporting will be made at Net AR.

ESI collection and follow-up tools provide:

• Automated dialer technology
• Time-sensitive worklisting (daily, bi-weekly, payor profiling, flag accounts, secondary billing and credit activities)
• Cash reporting at the collector level
• Statements, customized collection and insurance letters
• Best Practice productivity standards are strictly enforced
• On-demand key indicator reporting

Denial Management is a key to ESI’s success which includes a program enabled by key tools to challenge denied or under-paid claims based on national and provider-established business rules. This is accomplished through automation, without increased staff. This program is built on mutually agreed-upon management criteria.

Over eighty percent of contested claim denials are overturned in favor of the provider, however, at many facilities most denials remain uncontested due to time constraints and the lack of appropriate follow-up tools. The issue today is the complexity of payor contracts and the amount of time required to validate payment amounts compared to what the provider should have been paid.

• ESI analyzes claim remittance data for denial codes, delays, remarks, and the accuracy and completeness of payments.
• ESI has a payer’s contract and compliance policies knowledge database. All contracts, electronic and paper, can be easily loaded for benchmarking to create a solid baseline for expected reimbursement.
• Remittance Administrator – A system to electronically captures the remittance advice and explanation of benefits information retrieved from payors and assimilate it with the health information system (HIS) for accelerated payment information.