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You are here: Home / General News / Increase Your Net Revenue with ED Triage Claims Payments

Increase Your Net Revenue with ED Triage Claims Payments

September 14, 2017 //  by Parathon Marketing

States using the ED Triage payment methodology by Medicaid and Managed Medicaid payers often have hidden and challenging reimbursement opportunities.

THE CHALLENGE:

  • High volume, low dollar accounts, which staff does not have the bandwidth to pursue or sees as low priority.
  • Confusing or absent denial codes shown on EOB do not indicate the reason for the lower payment, nor the information about the opportunity to provide documentation for additional reimbursement
  • Outsourcing low balance vendor does not manage these accounts as clinical denials or have a working knowledge of ED Triage payment methodologies from Medicaid or Managed Medicaid payers
  • Some hospitals are unaware of situation or accept triage payments only – forfeiting a significant amount of revenue

THE SOLUTION:

  • Streamlined process to appeal these denials within short timely filing deadlines.
  • Expert knowledge in Medicaid and Managed Medicaid methodologies of all affected states
  • Technological and clinical staff expertise that can work these low dollar, high volume claims in a fast and efficient manner
  • Proactively recognizing opportunities, issues, and trends to make immediate adjustments
  • Generate meaningful performance reports that provide clarity on accounts that can be overturned
  • Attentive nursing staff who identify patient’s who frequently visit the ED and work with insurance case manager to help the patient find a PCP, which will help to reduce unnecessary trips to the emergency room

Revenue integrity is vital for hospitals in an ever-changing healthcare environment.  It has become necessary to have a solid process in place or to work with a vendor that has the expert knowledge and high success rate as another component in the revenue cycle continuum.

Category: General News

Previous Post: « The True Cost of Denials
Next Post: EMR/EHR Systems: Increasing Your ROI »

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