Minimize Claim Denials and Sustain Revenue

As a financial executive for a hospital, health system or employed practice, you know medical billing denials are constant headaches that negatively affect your organization’s revenue, cash flow and operational efficiency. As denial rates increase and compliance becomes more complicated, successful revenue cycle leaders must constantly tackle the root causes of issues that prevent cash flow.

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Relieve Your Team of the Burden of Denials and Backlogs

The numbers tell the story. One out of every five medical claims has to be reworked or appealed, but staff members are overburdened with higher priority projects and unable to address most denials – yet when denials are appealed, success rates can vary from 55-98%1. Today’s hospitals can no longer afford to write off 1-5% of net patient revenue due to a backlog when there are options to keep that revenue2.

The good news is that many medical billing denials can be minimized, reworked and appealed successfully with a third party like web2pro addressing them on your behalf. web2pro helps your organization reduce a backlog of administrative and clinical denials and address upstream coding or editing problems to minimize future denials. We contact payers on your behalf to dispute discrepancies, such as underpayments, and pursue a quick resolution. If necessary, web2pro stays on top of ongoing payer follow up that may take weeks, which means you don’t have to hire additional coders or staff.

A Denials Management Team That’s On Your Side

Our denials management team has decades of experience working with a diverse array of healthcare providers from the largest health systems to independent practices. We work on your behalf to bring better financial health to your organization. Our denials management team frees your team to focus on concurrent reviews and improve the accuracy of the bills going out the door.

Denials and Underpayment Recovery

From full outsourcing of your denials resolution procedures to performing focused audits, our denials management team can offer as little or as much help as you need to maintain control of your financial performance.

  • Revenue Cycle Improvement: web2pro helps you improve your clean-claim rate, address root causes of denials and keep cash flowing through your organization.
  • Denials Management: We help your organization manage denied claims from first appeal to final resolution. By having a third party like web2pro take the time to analyze payer adjustment codes from the remittance advice, including case management and utilization review, the administrative burden of managing denials and the risk of a write-off are reduced.
  • Underpayment Resolution: We contact payers to dispute discrepancies, including underpayments, for a quick resolution. We work with payers on behalf of your team to resolve interpretation differences due to contract, policy or documentation conflicts.

Payer Audit Services

We help your team manage payer audits from both commercial and government payers, including third-party defense audits.

  • RAC Audits and Other Payer Audits: We provide appeal services for Medicare’s intention to “take back” prior payments under the Medicare Recovery Audit Contract Program (RAC), in addition to addressing other commercial and government audits that your organization may face.
  • Documentation Requests and Appeals: By coordinating the process of medical chart reviews and submitting appeals within specific time frames, web2pro can relieve the administrative burden from your staff in the patient financial services, case management and health information management departments.

Ongoing System Edit and Workflow Maintenance

web2pro’s expertise helps guide your organization to implement appropriate edits and workflow modifications designed to address ongoing regulatory, payer and industry changes.

  • Regulatory, Payer and Industry Compliance: web2pro stays abreast of regulatory changes in the industry, reviews and implements payer bulletins and associated changes, and provides educational tutorials to staff. Our investment in staying on top of constant regulatory, payer and industry changes helps your organization achieve a proactive denial management approach.
  • Edit Updates: To enact the necessary adjustments due to payer compliance updates, regulatory changes, system modifications and other ongoing changes, providers must constantly modify upstream processes and “edits” in patient accounting and claims management systems. On your behalf, web2pro can stay on top of ongoing edit maintenance and cleansing in your system in order to keep claim submissions – and cash – flowing smoothly.

Detailed Reporting

We deliver detailed reports that provide insight into the processing and resolution of denials, underpayments and audits.

  • Trending Insights: Providing more than a report, web2pro clients gain valuable trending insights and recommendations for documentation, edit improvement, claims management and process improvement so they can address the root causes of claim denials.
  • Payer Contract Negotiations: Denial and underpayment trends and insights can provide your organization with information needed for upcoming payer contract negotiations.

The Strength of web2pro’s Compliance Team

web2pro has implemented our own “Gold Standard” compliance program that meets and exceeds the Office of Inspector General requirements.

  • Experienced: Our team has claims management expertise with most major US commercial and government payers and has worked with large and small health systems alike. Our clinical team understands what it takes to avoid denials, improve documentation and recoup revenue from payers due to improper denials.
  • System Agnostic: Our expert team of clinical staff works remotely within your system.

1, by Rebecca Mendoza Saltiel Busch, CRC Press, HIMSS Book Series, 2016, ISBN-13: 978-1-4987-5773-7.
2“ ,” by Kelly Gooch, Becker’s Hospital CFO, July 26, 2016