HOSPITAL RECEIVABLES

 

´╗┐Due to ever changing regulations and insurance company requirements, managing hospital receivables has become a complex, time consuming and sometimes difficult task. While at the same time hospitals and physicians are under ever-increasing pressures to improve cash flow and revenue. Group J Healthcare Financial Solutions has the expertise to streamline and simplify the process for you. To maintain good financial health, Group J helps healthcare organizations liquidate account receivables on a timely basis to expedite cash flow. Since 1988, we have been committed to maintaining the highest principles regarding billing and collections for hospitals.


Denial Management

Group J's Denials Management System (DMS) means increased billing accuracy and a decrease in the time you wait for reimbursement. Without proper medical coding methodologies, providers and practices will not receive the correct reimbursements, if any at all. We also analyze your medical records and previous coding to ensure that, if audited, your documentation will support the codes submitted.

 

Effective denials management and APC management has assumed greater significance in healthcare revenue cycle operations with the shift in reimbursement toward more prospective payment system (PPS) methodologies, coupled with an increasing proportion of services provided on an outpatient basis.

 

Did you know that:

Hospital Outpatient Prospective Payment System claims error rates
25% - 40% of all claims are either delayed via editing or are denied
50% of denied claims are never re-filed
90% of denials are preventable
67% of denied claims are recoverable

 

In a typical healthcare system, about 20% of rejected outpatient claims are never resubmitted. A maze of policies, billing requirements, regulations, as well as complex managed care contracts contribute to the number of denials that go unattended. Our DMS will take control of your denials; provide efficient claims processing and accelerated reimbursements.

DMS can uncover and correct the problems that lead to denials, so you can shorten your revenue cycle and enhance your cash flow.

 

Billing and Follow-up

Group J's customer service staff is trained to maximize patient contact and collections in an efficient and courteous manner. We have the ability to follow-up on both uninsured and residual patient receivables, perform insurance verification and billing, and provide payment plan monitoring.

 

For uninsured patients, Group J provides an effective solution for managing accounts that incorporates a progressive letter series with specific calling campaigns to maximize contact with patients. Accounts are segregated based on each patient's particular situation and handled by highly experienced customer service representatives.

 

Group J can assist in the set-up and maintenance of payment plans for Self-Pay patients. Following hospital specific guidelines, we will negotiate payment terms and send monthly reminder letters to patients, as well as follow-up on any broken payment arrangements.

 

Medicaid & Medicare Underpaid Claims Audit Review

Hospital payment systems are extremely complicated with numerous rules and regulations, along with expanding requirements on how a claim is paid.

 

Our experience is that a small percentage of claims get underpaid due to the complexity of the payment systems.

Group J is a leader in reviewing paid claims. Our experience and knowledge of the payment system has resulted in the recovery of significant sums of lost revenue.

 

Third Party Collections & Follow up

Group J's billing solution is capable of reducing "first pass" rejection rates. Using an 837 format, our claims are filed accurately and on a timely basis to insurance carriers through our web-based billing solution.

 

Our billing solution is designed to pass edit validation consistently. Edits are worked and claims resubmitted within 24-48 hours of identification of errors. We also provide tracking and status updates on accounts until final disposition.

 

Initial claims are submitted to governmental and non-governmental third party payers. Group J accepts all bill file formats, including print images and non-standard formats. Rejections are worked and claims are re-submitted through electronic responses back to insurance carriers. Hospital revenue cycles are improved through detailed reporting of this information.

 

Billing secondary insurances can be time consuming and manually intensive. Our automated, web-based claims process helps to expedite the secondary billing process. Group J has a comprehensive compliance program in place to help for Government billing programs. Our processes can also reduce the Medicare front-end claim process. CCI and LMRP edits are included to help prevent billing errors and provide a robust audit trail for every claim.

 

Bad Debt Collections

Our protocols are compliant with HIPAA regulations. Our bad debt solution is designed to identify those accounts that are likely to pay and results in higher recoveries for our healthcare clients.

 

Our customer service approach for collection services provides patients with a clear understanding of their fiscal responsibility to our healthcare clients. When necessary some of the solutions offered include: collections, skip tracing, bankruptcy reviews, insurance identification and verification, credit bureau reporting, and various legal options.