Claims Management

Maximizing Reimbursement and Minimizing Burden

Streamline processes for efficient healthcare operations and optimal reimbursements

Is there another industry where an organization has to scratch and claw for their earned revenue more than healthcare? Hospitals and providers are in the trenches of their communities, providing life-saving treatment – not insurance companies. So why are payers thriving while providers scrape by? At HCM, we believe community health is dependent on the financial health of the care organizations serving them. We’re bridging the gap to a more balanced financial equation.

Day 1 Billing

Claims Denial Management

Safety Net Services

Trend Projection & Analysis

Combing through hundreds of thousands of claims to ensure clean submissions was resource intensive before payers began the tactic of constant requirement shifts and policy updates. Couple that with labor constraints and revenue cycle teams are stretched thin. The end result has been an increase in denials and cash lag for care organizations. HCM offers Day 1 services that utilize optimized claim scrubbing and automated workflows to create a more even playing field. From full outsource to scoped services, we’ve been able to help clients:

Improved clean claim submission rates
Accelerate cashflow
Decrease prior authorization and pre-certification denials

Payers have made increasing denial rates an operational priority the last year. They’re reinvesting in the latest automation to deny claims at quicker rates. They’re making medical necessity and submission criteria even more complex. Our focus with denials management is to leverage our team’s decades of payer experience with advanced algorithm modeling to generate automated workflows for quicker resolutions and higher rates of appeals success. Our denial management services have achieved:

Reduction of days in A/R
Identification of upstream opportunities
Reduction in cost-to-collect

As revenue sits in limbo, the likelihood of reimbursement decreases while the cost-to-collect increases. Revenue teams are often faced with the difficult circumstance of determining which claims to prioritize while understanding the organization can not afford to sacrifice any of it. This is when having backstop support to focus on the revenue your team can not the time for is beneficial. HCM can provide these support services at a no-risk cost structure as well. We’ve been able to drive results on aging A/R during:

Legacy system conversions
New location mergers
Staffing shortage periods

Data analytics can offer guidance to organizations on risk mitigation, operational improvements and better decision-making. We believe in it enough to have an entire in-house data science team that can ingest client data to produce trend reporting and accurate cash projections. These reports not only allow our team to be more effective with revenue capture but also assist clients with identifying:

Claim denial root causes
Payment inaccuracies compared to cash projections
Contract issues weighted in payer’s favor