measure claim reimbursement accuracy

Salvum Health

Do you know the exact payment you should be receiving for each claim, based on your contract with the Payor?

How well are you measuring the accuracy of your reimbursement?

Are you aware that that your contracts include clauses for penalties and interest for mispaid, or incorrectly denied claims?

The old adage that what gets measured gets managed has never been truer than when understanding and managing your reimbursement from Commercial Payors. We help provide the data and reporting you need to collect what you are contractually owed.

You should be paid correctly, and timely. Let us help unlock the reimbursement you deserve.

Use your Contract Management data to collect more money

Step 1

COUNT the deficit between what your contracts say you are owed and your actual reimbuesments. Track using control charts

Is your Payor Payment Process “In Control”? Create a baseline of your Monthly numbers.

step 2

CATEGORIZE your outstanding variance between your calculated contractual amount and the received payment, by Payor, using Pareto charts

Step 2b

Drill down in largest category to get closest to root cause.

Step 3

CAUSE: Determine the root cause for the difference between what you were paid and what you should have been paid by using a fishbone diagram.

Step 4

CORRECT the process and systems using counter-measures, action plans, and a proven and consistant retrival process.

Step 5

CONFIRM that the correction yielded the desired results using Control and Pareto charts

Details

Finding and Fixing Denials and Rejections through Statistical Process Improvement

Challenge

Your Patient Financial Services department has many things to do during the day. Most are too busy trying to catch-up with the current days work to spend the time getting to the root of billing problems.

Solution

Let Salvum Health help you find the areas of your claims processing which needs the most help and can make the biggest impact on your entities finances. We do the heavy lifting of using Lean, Six Sigma and Statistical Process improvement methodologies to find the most profitable areas of quick improvement. More than that, we provide you with the tools you will need to monitor your processes going forward.