Transaction Management Assessment

TechnologyAssessment

Staffing & Organizational Assessment

Denials Management Assessment

Reimbursement& Revenue

Enhancement Strategies

Bad Debt & Pre-CollectAssessment

AccountsReceivable

Assessment

Billing & Claims EditingAssessment

• PR

OCESS REDESIGN •

Revenueoptimization

TE

CH

N

OLO GY E NABLEM

EN

T

Our denials management assessment services are designed to assess the impact

denials are having on the organizations bottom line, as well as understand the drivers

contributing to lost revenue for services rendered.

Our approach will identify the current state of denials management reporting, and

denials prevention within the revenue cycle and provide recommendations to allow the

organization to achieve performance excellence and minimize financial risk.

Denials Management Assessment Services

Our services include a review of

current state denials reporting,

identification of drivers, and the

impact on net patient service

revenue. Based on our findings,

we will select a sample of

accounts to identify root causes

and process improvement

initiatives to improve revenue

capture and patient satisfaction.

FREEDMAXICK.COM | BUFFALO BATAVIA ROCHESTER SYRACUSE | 800.777.4885Freed Maxick Healthcare is the brand under which Freed Maxick CPAs, P.C. provides services to its clients. Square logo, FreedMaxick, and “Trust Earned.” are trademarks of Freed Maxick CPAs, P.C.

Potential scope & approachThe overall objective of the assessment is to identify oppor-tunities to improve revenue capture and minimize financial risk to the organization by leveraging people, processes, and technology. Our approach includes the following four key areas of focus: review of historical data; assessment of current state denial reporting; financial impact and drivers; and process improvement assessment.

THE SERVICES MAY INCLUDE THE FOLLOWING:

1. Historical data reviewConduct analysis of third party payer denial activity including: •Annualcontractualallowancewrite-off activity for denied claims to determine impact on net patient service revenue.

•Reviewofcurrentremittanceprocessing and denial transaction reporting to verify accuracy of contractual allowance reporting.

2. Current State Denial ReportingWill review and evaluate the organization’s current state de-nial reports and provide information for timely identification and resolution of denied claims that includes: •Abilitytoidentifydeniedclaims by denial category and process owner

•Abilitytoassessfinancialimpactand lost revenue by denial reason

•Identifygapsinreportingand recommendations for improvement

3. Financial Impact & DriversPerform a financial impact analysis of current state denial activity to identify trends and opportunities for improvement that includes: •Lostrevenuebypayer,visittype,andservicearea •Topdenialreasonsandfinancialimpact •Denialclassificationandsource

4. Root Cause Analysis & High Level Process Improvement AssessmentWill validate findings by conducting a review of denied encounters to determine root cause, then identify the break down in revenue cycle process or technology. The key considerations include: •Identificationofpayerrequirements at point of scheduling and or service

•Abilitytoidentifyandverifyinsurance benefits prior to service

•MedicalNecessityreview,notification, and determination

•Timelyandaccuratecoding

•Timelyandaccurateclaimsubmission

•Technologyassessmentandaccesstoinformation

5. Deliverable Our deliverable includes findings and recommendations that highlight key issues driving denials and the financial impact on your organization. We identify necessary steps to becoming a best practice organization with a focus on prevention, monitor-ing and reporting, and revenue capture by: •Calculatingthefinancialimpacton Net Patient Service Revenue

•Identifytopdenialreasons,drivers,&payeractivity

•QuantifyImprovementOpportunity

•Recommendationstoenhance denial reporting and trending

•Recommendationsforpreventionthrough knowledge transfer, process improvement, and technology enablement