CentraMed Denials™

Cloud-based denials analytics software with expert analysis will provide substantial short and long-term reimbursement improvement

Value Proposition:

CentraMed Denials analyzes your electronic remittance file and categorizes denied charges into relevant groups, creating easily managed work lists. This combined with our expert analysis and weekly denials workshops helps to increase revenue, reduce A/R days, improve productivity and increase the speed of reimbursement.

Detailed Solution Overview:

CentraMed Denials combines the power of business intelligence with expert consulting services to help providers expose trends, uncover hidden problems and create indexed work lists, which result in much higher reimbursement and increased productivity. CentraMed Denials groups denials codes into meaningful and efficient categories that can be pursued by your team. By analyzing the ANSI 835 file the solution can uncover and highlight trends that are impacting denials disproportionately so that process improvements can be made; additionally, the 835 file is processed daily to ensure the most current view of all denials and associated work efforts.

The CentraMed business intelligence platform offers pre-built dashboards and reports for denials management metrics and also allows for custom dashboards as well as ad hoc reports. The pre-built and ad hoc reporting feature reveals powerful analytics as well as actionable information, based on denial trends, that when implemented, can result in significant reimbursement improvements.

CentraMed Denials™ is a cloud-based solution; it can be up-and-running immediately. It’s packaged as an affordable monthly subscription fee that includes both denials analytics software and expert consulting services and provides immediate return on investment.
Some specific features of the solution include:

  • Intelligent work queues – Denied claims are routed to the appropriate biller’s desktop
  • Automated appeals letters
  • Filing deadline alerts –the system will generate an email to the biller and their supervisor notifying them about a filing deadline
  • Auto-generated email for an unusual increase in denial types. Parameters for threshold alerts can be set by user and can be specific to any combination of categories

Financial Dashboard – The financial dashboard has two distinct areas:

High Level Summary: The financial dashboard provides a snapshot of a facility’s present denials status, showing denials as a percentage-of-charges-by-payer as of midnight the previous day. Additionally, the dashboard displays a summary of all denied charges which are presently in the system, waiting to be worked by the staff.

Reporting: The system comes preconfigured with several reports for monitoring productivity as well as cost. Some specific categories of reporting available to clients include:

  • Top Code Reports (Denials by HCPC/Rev Code/Denial Code/Remark Code)
  • Trend Graph – Denials grouped by Duplicate Claims – 12 months
  • Trend Graph – Denials grouped by Missing Certs and Auths – 12 months
  • Trend Graph – Denials by Benefits Exceeded – 12 months
  • Trend Graph – Denials by Billing Reasons – 12 months
  • Trend Graph – Denials by Coding Reasons – 12 months
  • Trend Graph – Denials by Eligibility Reasons – 12 months
  • Trend Graph – Denials by Billing Time Period – 12 months

Denials Workshop

All denials data is summarized by the system and reviewed by CentraMed, analyzing problem areas and/or opportunities where a facility can take steps to minimize or even eliminate specific types of denials. CentraMed will present these findings to the client staff, typically on a weekly basis. This is referred to as the Denials Workshop, where all denials data is reviewed summarized and presented to the client.

Bottom Line:

CentraMed Denials will likely identify a minimum of $500,000 in reimbursement that can be collected within 60-days of implementation.

 

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