The key pain point in the RCM business is inefficient and insufficient follow-up of claims in an outsourced environment. Your limited visibility into the AR process creates surprises at the end of the month when you measure reimbursements against costs incurred.

Reimburssence provides the AR team with the information and the tools necessary to perform their main task – collections. Reimburssence pushes claims towards resolution, versus “working” the claims to preset patterns.

Teams using Reimburssence are “oriented” towards “closure,” since our clients do not benefit out of pushing claims from one bucket to another. Reimburssence is a catalyst that builds a “collection” work culture.

How Reimburssence impacts reimbursement

  • Interfaces with Practice Management Systems
  • Enhances workflow management, priority queues and action matrix-based design
  • Can be tweaked dynamically to suit your business
  • Allows control and visibility to you as a client
  • Ability to identify, track and work the right claim at the right time
  • Allocates claims and monitors till closure
  • Assist and support feature nudges staff towards correct actions
  • Knowledge-base automation for global action, consistent output and predictable results
  • Routes claims to the appropriate resolution workbench
  • Automates appeal letter generation
  • Wasteful and repeat AR follow up are passe
  • Provides number of touches to closure; a key statistic for measuring effectiveness

Collection & Resolution Effectiveness

Analytics, Intelligence and Insight are three powerful drivers that enhance the effectiveness of Collections and Resolution.

Analytics

An overused term, but within the Reimburssence a context helps measure the team’s collection efficiency. It also helps uncover trends from payer denial / underpayment behaviour.

Intelligence

Reimburssence provides insights on Collection Effectiveness based on the parameters you want measured, like resubmission or resolution effectiveness, appeals effectiveness, insurance resolution timelines and denial trends.

Insight

With Reimburssence you can find out the rate of first-touch resolution, number of claims crossing payer deadlines, number of claims with multiple touches / repeat touches, etc.

We’ve defined below the implications of Collection and Resolutions effectiveness, in terms of its specific benefits.

Collection effectiveness

  • Propensity to pay / adjust
  • Resubmission effectiveness
  • Appeals effectiveness
  • Adjustment reduction
  • Payer resolution timelines
  • Payer / denial collection trends

Resolution effectiveness

  • First-touch resolution
  • Claims crossing applicable timelines
  • Multiple touches
  • Adjustment trends and controls
  • Payer/denial closure trends