A/R Recovery & Denials Management Platform

Leverage AI, analytics and automation to realize a 2 to 5% net patient revenue uplift and 20% net new collections from A/R and denied claims.

POWERED BY AI & AUTOMATION

Accelerate Payments & Reduce Denials In One Platform

Get faster claim reimbursements, avoid underpayments, decrease cost-to-collect, and reduce denials with our cloud-based, revenue-boosting A/R Recovery & Denial Management platform.

With intelligent claims prioritization, automated follow-ups, and rich analytics dashboards powering our platform’s A/R Optimizer and Revenue Insights modules, clients realize 2 to 5% net patient revenue uplift and 20% net new collections from their A/R and denied claims.

Clients also benefit from more accurate revenue modeling to improve their operations and bottom-line margins by preventing unnecessary lost revenue before claims become write-offs.

A/R OPTIMIZER MODULE

Boost Reimbursement Recovery

Armed with multiple real-time data points, including clinical data, our prediction algorithms are able to accurately predict the recoverability of outstanding claims.

Daily work orders are assigned to team members by prioritization algorithms so they can focus on working claims with the highest probability of reimbursement in the shortest amount of time rather than the typical focus on high dollar claims and claims close to timely filing limits.

Automated status checks help prevent claims from going unworked and aging out, leaving A/R teams free to focus on high-value work and touch more claims.

Analyze

claims inventory for actionable insights

Predict

recovery at claim and charge level

Prioritize

claim work queues for maximum recovery

Recover

payments with bots and intelligent workforce management

Optimize

with actionable insights from data pulled from recovery operations

REVENUE INSIGHTS MODULE

Real-Time Data Helps Providers Pinpoint RCM Issues

With our Revenue Insights module, executives can assess their organization’s financial performance in minutes. Instead of manipulating data in spreadsheets for hours, they can view revenue cycle performance on demand in a single interactive dashboard and make proactive decisions with timely analytics.

Our advanced analytics technology centralizes revenue cycle data from multiple siloed systems and performs multi-modal examinations to identify reimbursement bottlenecks and revenue opportunities.

With the right insights delivered on time, executives can base their decisions on data and facts rather than guesswork. They can visualize the contribution of underlying factors like those listed below impacting revenue cycle KPIs and respond with corrective action:

  • Assess recoverability by payers, procedures, facilities, denials, and aging buckets;
  • Which payers and procedures are not getting reimbursed and why;
  • Assess reimbursement shortfalls and by how much;
  • Locate denial hotspots, anomalies, and rejection patterns; and
  • Detect denial patterns before they further adversely impact financial performance.

HIGH VOLUME THROUGHOUT

Billions Of Transactions Processed Annually

15K+

claims prioritized daily

408K+

claims predicted for recovery monthly

346M+

NPR recovered annually

$8B+

collected to date

STEP 1

AI Analyzes Claims Inventory For Insights

Complete RCM KPIs

Integrates clinical and revenue cycle data across multiple EHR and billing systems to provide a comprehensive oversight of current A/R inventory.

A/R inventory & denials insights

Enables visibility into the various A/R categories and supports deep analysis across multiple dimensions like facility, payer, denial and aging categories.

STEP 2

AI Predicts Claim Recovery

Charge recoverability

Continuous AI-powered predictive analysis of all outstanding A/R and denial inventory to determine recoverability at a claim or charge level.

Robust prediction model

Our prediction models operate at a high degree of accuracy and take into account claim status, payer guidelines, procedures, contractual allowed, denial complexity, remittances made, and more to determine recoverability.

STEP 3

Claim Work Queue Prioritized For Maximum Recovery

Manage claim work queues

The prioritization algorithm automatically ranks and assigns a prioritized list of claims for A/R and denials specialists to resolve.

Operational constraints considered

Algorithms factor in not just the predicted dollars and timely filing limits, but also additional operational constraints including recently worked accounts, team skills, agent availability, productivity throughputs, and more in prioritizing work queues.

STEP 4

Recover Payments With Bots And Intelligent Workforce Management

Integrated workforce + automation

Automation capabilities integrated into workforce management perform automated claim status checks across payer and clearinghouse portals to cut down time spent by agents per claim.

Automated appeal support

Templated appeal letter creation and submission ensure consistency and quality of recovery efforts.

STEP 5

Optimize For Continuous Performance Improvements

Measure productivity

Measures the overall productivity and effectiveness of A/R recovery operations.

Improvement insights

Provides insights into the available areas of opportunity for resource and work planning.

HELPFUL DASHBOARDS

Drive Performance Improvements With RCM KPIs

Here are some dashboards our clients find useful in reviewing when determining where correction revenue cycle optimization action can take place.

A/R Inventory Analytics

Provides single source, comprehensive visibility into current A/R and denial inventory status.

Payment Trends

Track payments, refunds, and net payments, by patients and insurance over time. Zoom in on facilities, procedures, payers and more.

Gross Collection Rate (GCR) Trends

See trends in collections over time, stratified by payer, facility, procedure and more.

Shortfall Data

Identify sources of shortfalls by CPT code, modality, shortfall amounts, and more.

METRICS THAT MATTER

Revenue Cycle Metrics We Track

Our solution measures itself against against the following KPIs to continuously optimize our clients’ revenue recovery performance:

  • Increase monthly collection $ to accelerate cashflow
  • Increase Gross Collection Rate (GCR)
  • Increase Net Collection Rate (NCR)
  • Decrease Days in A/R
  • Decrease A/R over 90 Days
  • Provides insights for denial prevention and reduce denial rate
  • Meet 95% QA audit performance
  • Exceed A/R specialist productivity targets

FINANCIAL BENEFITS

Positive Results After Implementation

2–5%

net patient revenue improvement

20%

higher A/R and denials recovery

15%

cost-to-collect reduction

30%

aging A/R reduction

Integrations

Compatible With Most EMRs

We offer bi-directional integration with most EHR/EMR/LIS/RIS with API, HL7, FHIR, X12 or EMR developer programs so that your staff can submit and update financial verification requests from your local system Here are some of the systems we integrate or are compatible with.

eClincalWorks
Infinx - Partner - athenahealth

Case studies

How We Help Our Clients

Learn how we work with our clients to solve their reimbursement and cash flow challenges.

Texas Cardiology Clinic Increases Monthly Collections $300K with AI and RCM Analytics

A well-regarded cardiology clinic with a number of locations in the Houston area, providing treatment for heart and vascular disease was looking for a revenue cycle partner to help increase reimbursements for their organization. They were experiencing lower than expected reimbursements and revenue recovery but were unsure of the cause. Our specialists worked with them to input their A/R data into our A/R Recovery & Denials Management platform, which uses machine learning to analyze A/R data by procedures, payers, aging, location and more to identify collection shortfalls and untapped revenue. It was discovered that the client was experiencing low reimbursements for intravenal and cardiovascular surgical procedures. The primary cause of the low reimbursements were denials due to the lack of prior authorizations. The platform quantified the depressed A/R recovery as a collection shortfall of 19%, caused by a lack of charge entry and A/R follow up. Learn how we helped them overcome this challenge.

Texas Cardiology Practice Reverses Massive Collection Shortfall, Increases Average Monthly Collections Over $59k With A/R Analytics

Experiencing significant A/R recovery challenges but uncertain of the cause, the practice turned to us to conduct an analysis of their A/R data. Based on the insights, our RCM specialists could identify specific reimbursement bottlenecks and formulate strategies to address outstanding A/R and undertake RCM process improvements to improve reimbursement rates. With nearly $10 million at risk, finding the source of the denials in the face of looming expirations was urgent. We moved quickly to implement A/R Optimizer module and evaluate the collectability of outstanding denials and accounts receivable and create a plan for resolution. After only three months, the practice had a significant turnaround in key financial performance metrics, including a $59k increase in monthly collections. Learn more about how we helped in this case study.

Faq

You Asked, We Answered

Curious if our A/R Recovery & Denials Management solution will meet your needs? Here are the most common questions your peers ask during evaluation.

Yes, our A/R and Denial Management platform is agnostic of healthcare specialties and can support any provider.

While the Revenue Insights analytics module can be used by a practice of any size, the A/R Optimizer prediction and prioritization functionality benefits organizations with at last $5 million in net patient revenue and at least $1M net in outstanding A/R inventory. Also, if your organization is experiencing KPIs like net collection rate of less than 85%, denial rate of over 12% and/or aging A/R over 90 days is more than 20% of your total A/R, you should consider leveraging our technology to help improve these metrics.

Executives like CFOs who need key financial statistics and analytics on revenue cycle performance and reimbursement trends for financial projections, performance benchmarking, risk assessment, and valuations. Revenue opportunities and avenues to cut costs can be identified. Predictable financial outcomes can be forecasted for better financial planning and success.

Revenue cycle leaders benefit from detailed monitoring of revenue cycle performance along with KPIs, trends, patterns, and study of contributing factors. Proactive process improvements are accelerated across revenue cycle verticals to prevent revenue leakage. Insights become visible on hidden revenue opportunities helping improve operational efficiency.

Revenue cycle operation teams are able to determine cause analysis of denials and reimbursement bottlenecks. They would be able to perform operational exclusions on current A/R inventory, prioritize and allocate workable claims to A/R teams and specialists, and automate operational reporting and productivity monitoring.

A/R and denial specialists are provided with a ranked work order of claims from workable inventory and the platform automatically keeps track of their touch progress.

You will need to provide charge, remit, and denial datasets for the past 2 years and on an ongoing basis. Additionally, some master files (Payer, Location) and configurational datasets (resources, workflow segments, exclusion/inclusion criteria) may be required to set up the solution in a way to work with your operational environment.

Our A/R Recovery & Denials management platform is EHR/billing system agnostic and can support any system that can render the required datasets. Examples of recent implementations include with Imagine, eClinicalWorks, Centricity, Cerner, Allscripts, Zotec, Telcor, and more.

The only implementation effort required, if any, is limited to enabling connectivity between the data source (billing system/EHR/EMR/reporting database) and our A/R and Denial Management platform for data extraction and transfers. If your system already generates the required dataset in flat file extracts, the solution can function on such extracts shared over SFTP to a secured location.

The A/R Optimizer module runs its prediction, prioritization, and work order allocation on a daily basis. While a daily prioritization and allocation is ideal, we recommend at least a weekly work allocation that is configurable during setup.

The work allocation is in a form of ranked order of claims delivered to the agents through the our A/R Recovery and Denial Management portal into individual accounts of agents.

No, agents will continue to work on the accounts and perform resolution activities in the existing client systems as usual. The A/R Optimizer shall just provide them with a guided ranked list of accounts to follow up without disrupting existing processes and client systems.

Yes, A/R operational segments can be configured based on your requirements and inclusion/exclusion criteria to best suit your operational team constructs.

The A/R Recovery and Denial Management solution supports flat file formats (.csv, .txt, .xls, .xlsx, etc.) and can directly consume data from report extracts of your system if all the required fields and parameters are available.

The Revenue Insights and analytics dashboards get automatically updated on every data refresh with the your source system. While a daily sync is ideal, we recommend setting up at least a weekly sync.

Yes, dashboard customizations, custom analytics, and visualizations are supported through professional services. Ask us about it when you schedule a demo.

No, they are custom configured and tuned for every client. Although the recovery prediction model hosts AI and machine learning curated knowledge of predictive intelligence based on learnings across our client base, they are re-trained on the your historical data to adjust and account for your unique revenue cycle practices and scenarios.

The artificial intelligence and machine learning models continuously learn from new claims and reimbursement data on a periodic basis. They identify and adapt to changing payer guidelines, billing changes, denial patterns, and reimbursement outcomes.

Our A/R Recovery and Denial Management platform is accessible through a web interface. Currently, only the desktop browser version is supported. Authorized users can log in to our portal with their registered username and password. A detailed user guide is available in the resource section for various modules that can be accessed post logging in.

To make sure of getting the best experience possible, we recommend using the most up-to-date version of one of the following browsers: Google Chrome, Mozilla Firefox, Safari and Microsoft Edge.

A detailed user guide is available in the resource section that can be accessed post logging in. We will provide adequate user training during user onboarding. A customer success manager will be assigned to your account to answer any questions you may have.

EDUCATION

Helpful Resources For Your Team

We create educational materials frequently in the form of virtual office hours, articles, white papers, webinars and podcast episodes which help our clients and peers with common patient access and revenue cycle challenges they face. If you would like us to address a specific topic, feel free to reach out to us.

WEBINAR

Key Revenue Cycle Metrics

WEBINAR

Improve Productivity And Efficacy Of Your A/R Teams With AI And Automation

WEBINAR

How To Effectively Manage Denials

ARTICLE

A Crawl-Walk-Run Hospital A/R Strategy to Enrich the New Year

WEBINAR

How To Prioritize Your A/R Inventory For Maximum Revenue Recovery

PRESS

How To Use Analytics And Automation To Build An Intelligent A/R Strategy

Reviews

Our Clients Grow With Us

As we streamline their organization’s patient access workflows, clients are happy with increased results, as well as improved cash flow due to increase in reimbursements and reduction of claim denials due to eligibility. They usually end up retaining us for other revenue cycle management tasks.

“Post pandemic onset, I had to rush to my drawing boards to revaluate risks, discover revenue opportunities, and find avenues to cut costs. With Revenue Insights, I get my answers out of the box. It has helped in benchmarking performance, identifying revenue risks ahead of time and bringing predictability to our financial outcomes.”

Chief Financial Officer
National Physician Group

“When you are managing A/R at an organization of our size, you really have to be at your best and strategize daily. A/R Optimizer has made life easy and efficient for my operational managers where they do not have to figure out where to invest efforts and what to allocate. The AI/ML-based recovery prediction is a game-changer and provides a continuous collection potential of A/R inventory. My team’s reaction time to resolve issues and work on new revenue opportunities has improved tremendously. With A/R Optimizer, we are seeing additional dollars flowing in, our net collection rates have improved, we do not have to write-off as much and our inventory aging is in a spectacular spot.”

Senior Vice President of Revenue Cycle Operations
National Radiology Group

“Before A/R Optimizer, I used to daily struggle crunching and analyzing the A/R inventory, filtering accounts, applying various strategies, resource planning, and manually allocate work to agents on the ground. But now, A/R Optimizer does all of that for me, and even applies multiple other dimensions to the prioritization strategy that I could always dream of applying manually. My time is now freed from data crunching and operational reporting. I am now able to focus on things where I am best at – spending time with my team to act on issues, and improve our RCM operations and reimbursements.”

Revenue Cycle Operations Manager
Large Imaging Center Group

Looking To Accelerate More Reimbursements?

Contact us to learn how our A/R recovery and denials management solution can help your organization get more reimbursements.