Reimbursement Integrity

Healthcare organizations and hospitals share common challenges –managing the risk of new reimbursement models, improving reimbursement rates, reducing days in accounts receivable (A/R), increasing efficiency, and managing complex contracts.

Reimbursement Integrity solutions help health systems prepare now for approaching changes in the payment system and future bundled reimbursement models in addition to improving financial performance throughout the revenue cycle.

These solutions and services support prompt and accurate payment, increased net revenue and improved cash flow due to the reduced errors, reduced denied claims, recovered lost revenue and improved upstream processes.

Accountable Care Management

Prepare for the shift from fee-for-service to fee-for-value and changes in the reimbursement payment system.

Improve patient outcomes and reduce costs related to managing population health with risk stratification, readmissions management and patient engagement. And, provide for the ability to manage and transact bundled payments via an episode of care Bundled Payment Solution. All of these solutions focus on improving patient outcomes and reducing costs.

Claims and Remittance Management

Improve first pass acceptance rate, cash flow and accounts receivable (A/R) days

A minimum requirement for health systems in the 21st century to be successful is meeting industry standards for cash flow and A/R days. The primary solution to meet those standards is a claims management solution that edits and processes claims submitted to payors achieving first pass claim acceptance rate, and integrated remittance and claim data into core accounting systems. MedAssets Claims Management can help health systems achieve these goals in addition to online, real-time submission of Medicare claims, a complete payment capture system for secondary payors, and improved the accuracy and consistency of cash and adjustment posting for proper A/R management.

Claims Audit Management

Streamline your payor audit and compliance processes

MedAssets helps health systems manage and track the complexities of claims audits through all levels of appeals from Medicare, Medicaid and other third-party payors, both Institutional and Professional claim types, replacing labor-intensive research and review with accurate, process improvement technology.

In addition, MedAssets can serve as your strategic partner to help assess and resolve your RAC and Medicare reimbursement issues. Through the actionable assessment of “complex cases” known to be targeted by RAC, MedAssets helps health systems to proactively identify compliance errors and quantify the financial impact of the RAC program with a comprehensive scoring breakdown, A clinical review and appeals services, using a team of physicians and nurses to review the documentation, helps you prepare compelling appeals in a timely manner.

Contract Management

Improve profitability by accurately forecasting and capturing all net revenue per payor contracts

Without the proper tools to manage contract inventories and analyze and compare contract rates and payment schedules, health systems often find themselves at a disadvantage. By verifying claims are paid correctly, providers can negotiate more favorable contracts, identify payor trends, improve collections, and forecast accurate revenue dollars. MedAssets Contract Management solutions and services help health systems simplify the payor reimbursement process to improve profitability.

Denials Management

Minimize payor denials and recover lost revenue

Managing the denial process is lengthy and time consuming, and MedAssets Denials Management helps you identify and account for all payer denials by targeting problem areas that affect the bottom line. In addition MedAssets can help you recover lost revenue by using managed care experts to appeal retrospective clinical and technical denials.

Receivables Management

Accelerate net revenue collections

To answer the challenges of the difficulty in managing aged receivables, MedAssets helps providers streamline the receivables management process and increase the productivity of in-house staff while accelerating net revenue collections. MedAssets solutions for revenue recovery and collections management ensure appropriate payment is received for the services provided–a key component of revenue integrity. MedAssets receivables management services and collections management solutions help manage accounts receivable performance to accelerate cash and to increase net revenues by providing management of the accounts receivable (A/R).

Improve your
Operating Margins

MedAssets improves
and sustains
operating margins
by 1.5% to 5%.

Dartmouth-Hitchcock Medical Center

Dartmouth-Hitchcock Medical Center improves clean claims rate, reduces A/R days, and improves billing compliance and effectiveness with no increase in revenue cycle FTE resources.