Our transaction management workflow assessment services are designed to assess the current process

for managing 835 remittance transactions, denials reporting, and accounts receivable management.

Our approach is intended to evaluate the current state of remittance transaction management and identify

opportunities to leverage system technology and transaction standards. Doing so will automate and

enhance denials management, secondary billing, cash collections, operational efficiency and productivity.

Transaction Management Workflow Assessment Services

Potential scope & approachThe overall objective of the assessment is to identify opportunities to leverage technology to reduce manual intervention, accelerate cash flow, improve revenue capture through timely follow up, and denials management processes.

Our approach includes five key areas of focus:

1. 835 Remittance transaction posting review Conduct analysis of 835 transaction posting including:

• PostingofClaimAdjustmentReasonCodes

• Postingofassociatedfinancialtransactions, payments and allowances

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

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OLO GY E NABLE

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2. Denial transaction management review Reviewandevaluatecurrentstatedenialreports and process for tracking, managing and appealing denied claims, which includes:

•Identifyingdeniedclaimsby denial category and process owner •Assessingfinancialimpactand lost revenue by denial reason •Identifygapsinreportingand recommendations for improvement

3. Accounts receivable reporting & workflow management Evaluate the current process for managing accounts receivable balances to include management of:

•PaymentVariances •PatientLiabilityBalances •SecondaryInsuranceBalances •DeniedClaims

4. Assess system functionality to enhance performance Assesscurrentprocessesandworkflowfor managing adjudicated claims and associated accounts receivable balances. In partnership with technology resources; identify opportunities to leverage system functionality to enhance performance in the following areas:

•AccountAssignment •ExceptionReporting •AutomatedBalanceTransfer •AutomatedStatementGeneration •AutomatedSecondaryClaimGeneration

5. Deliverable Our deliverable includes findings and recommendationsthatwillenhanceRevenue Cycle performance through the use of your vendor system technology and transaction standards. We identify necessary system enhancements toleverageexistingtechnologythatwillenhance denials reporting, accelerate cash flow and improve productivity and performance within revenue cycle operations. We will provide the following recommendations to:

•Enhancetransactionposting

•Enhancedenialreportingandtrending

•Streamlineaccountsreceivablefollowup

•Streamlinesecondarybillingand patient statement generation

•Enhanceperformancethroughknowledge transfer, process improvement, and technology enablement