Our Solutions:
Revenue Integrity and Charge Capture
Note: Hospitals may refer to these program as
Charge Capture Audit, Internal Audit, Revenue
Reconciliation, Case Management, Utilization Management,
Accelerated Cash Collections, and Performance
Improvement.
After services are delivered, ESI’s Revenue Cycle
Solutions maximize revenue capture and streamline the
billing and collection process with coding compliance,
online secondary billing, remittance posting, document
imaging retrieval, contract denial management, and
financial analysis. This program includes a complete
review of all inpatient, outpatient, and ancillary
billing details with clinically based rules technology,
providing key education and workflow back to the
department level and clinical staffing areas.
ESI’s Business Process Outsourcing Solutions within
the revenue cycle help to prevent denials at the source
by applying rules and lessons learned through the
challenge process to services before they are rendered
and/or billed. These programs extend into the clinical
department, with service Dashboards to promote “Open Book
Management,” to monitor services as well as workflow.
ESI provides:
- Monitoring of all services prior to discharge
for charges that could result in a denial or reduced
reimbursement. ESI analyzes the service data
received from the legacy system or manual booking
process for missing information that is critical for
revenue management to prevent denials.
- The revenue cycle is dependent on the charge
entry process. Accuracy and verification of charges
is necessary and critical for reimbursement.
- ESI will associate rules for automated policy
and procedures for each key missing data element or
claim type to ensure the collection of such
information. Workflow tools are integrated to
automatically distribute the workflow for these
real-time problems such as insurance eligibility and
authorizations, to the appropriate follow-up staff.
- ESI monitors and analyzes the payer’s contract
and compliance policies. ESI will identify key data
requirements for each carrier and procedure in the
service based on the contract management rules. ESI
will trigger workflows to gather the missing data
and ensure compliance with contract terms and
policies.
- For Medicare patients, ESI ensures that all
required data is available to test medical necessity
with available tools and data. If medical necessity
is not determined, ESI initiates the self-pay,
Medicaid, and charity workflows based on facility
policy.
- When the service has been rendered, ESI monitors
for changes or additional procedures associated with
the service. If a change is detected, it will
automatically trigger additional workflows to ensure
that such changes stay within established limits.
- Case management is coordinated with the entire
revenue cycle process. Case management may be
provided by ESI or coordinated for your facility
staff, and includes the following:
- All denials and reimbursement terms are
monitored to assure maximum reimbursement for
all approved cases.
- Patients’ length of stay is monitored and
days are approved by clinical case managers.
- Managed care plans stay informed by ESI and
clinical case management for accuracy of
reimbursement.
