Every Practice and medical coding and billing company is at some sort of war when it comes to AR and denial management of their Revenue Cycle management. The constant need to prevent claims from piling up in the AR is a challenge that even the big players in the industry face. This is because AR follow-up is the toughest in the Revenue cycle management process. AR follow-up is a B2B interaction, it involves transaction(s) resolutions relating to reimbursements over the phone. This calls for usually dealing with fortune 100 companies with budgets for process and technology that are hundreds of times more than what the provider can access.

Traditional measures for success of this process were in terms of turnaround time, the number of claims touched/worked, and process adherence. Reimburssence seeks to change these legacy approaches by measuring outcomes and impact, like claims resolutions, collections, and unpaid closures

This is a global problem. There are other transactional issues as well,

  • Wastage of effort directed at claims that weren’t ready for follow-up.
  • Multiple touches of a transaction with no relation to global trends.
  • Time-consuming manual processes, e.g. Creating appeals.

What were the core problems in the AR part of the Revenue cycle management?

  • Poor inventory control resulted in redundant claims being worked that did not direct towards claim resolution.
  • Inconsistency in the output at the same time a mismatch in skill and challenge.
  • Claim allocation and with no reliable algorithm for the need to be worked claims.

How does Reimburssence tackle these issues?

  • Claim resolution efficacy – Reimburssence helps in measuring the Claims resolution efficacy.
  • Optimizing allocation – Reimburssence focuses on working the right claim at the right time. This is done using past payer behavior and response lags. Claims get auto-allocated or directed by supervisors based on the user skill and inventory level.
  • Learned pathways – AR assist is a library of pathways for the multitude of payer denials/low pay/no pay scenarios. The source of the library is a validated denial Matrix. Reimburssence guides users to take the most appropriate action on a claim when the pathway is followed.
  • Touches to closure – It is possible to track the life cycle of the claim, the number of touches, and the user efficiency of every touch.
  • Measuring user efficiency – With Reimburssence we can identify individual users’ effectiveness by mapping to closure and reimbursement.
  • Appeals automation – Built-in Bots within Reimburssence handle multiple appeal letter templates which auto-fill the appropriate data. The integrated workflow also helps in retrieving medical records to match the cover letters. Filled-in forms are routed to the concerned department for final review and submission.

Quintessence believes that a success of a solution is in the numbers. Here are some true facts and figures of one of our clients who have implemented Reimburssence in their Revenue Cycle Management process.

  • Reduced effort on “in-process” claims, effort directed at the resolution of the productive claim. Quantified results: Increased <60 days collections by $0.5 million across 5 clients over 6 months. <60 days collections increased by 9.79% over 9 months.
  • Appeal automation has helped Increased Productivity from 72% to 90%
  • Tacking user-level effectiveness and monitoring claim touches helped in the liquidation of over 25000 Charges worth $2.2 Million.

The wow factor to any intelligence lies in its ability to resolve multiple issues with a single solution and that’s what Reimburssence is all about.