Topics: Denials Management, Revenue Cycle, Finance
In an era of razor thin margins, shrinking cash reserves, and health reform-driven reimbursement pressure, providers cannot afford any avoidable revenue leakage. Although providers have made significant investments in systems and staff to curb leakage, six obstacles stand in the way of breakthrough payer performance and payment integrity:
- Hidden and siloed data limits visibility into true revenue potential
- Finance teams under-resourced to manage increasing payment variances
- Managed care at a disadvantage in negotiations with payers
- Systems unable to accommodate evolving contract complexity and payment reform
- Transition to ICD-10 could double the claim error rate
- Growing professional revenue cycle and introduction of bundled payments raises complexity
The average gap between expected and actual payment on commercial contracts is approaching 10%—a spread conservatively valued at $2-3 million for the typical 350-bed facility—creating newfound urgency to ensure proper payment and maximize contract yield across all payers.
What is the Payment Integrity Compass Initiative?
Payment Integrity Compass—powered by Concuity technology and Advisory Board research and services—is a unified solution for pinpointing all payment discrepancies, streamlining denials and underpayment workflow, aggressively recovering revenue, and maximizing yield from all payers and contracts.
Payment integrity and payer performance technology
Our ASP technology platform provides secure, Web-enabled software access without the need for a large-scale, expensive software installation.
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Precise calculation engine pinpoints all payment discrepancies to reveal true revenue potential.
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Advanced workflow functionality boosts collector agility and ability to coordinate seamlessly across departments to overturn more denials and increase underpayments recovery.
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Robust financial dashboards and reporting tools allow quick identification of patterns and trends in payment performance in order to find and fix root causes of discrepancies.
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Sophisticated contract analysis and modeling arms staff with data and scenario analysis to level the playing field with payers, improve negotiations, and increase contract yield.
Consultative implementation support and training
Our team of experts assists with project management; contract interpretation, analysis, and loading; tool configuration customized to your requirements; and onsite training of end-users.
Outcomes-focused dedicated advisor service
We pair every member with a dedicated advisor, who functions as both educator and analyst, identifying immediate and long-term opportunities, reviewing data to support performance gains and prevent backsliding, and sharing peer organizations’ stories and best practices.
National network of progressive, like-minded hospitals
Our members are part of a rapidly expanding national network of more than 200 hospitals, whose willingness to share best practices fuels the cohort’s progress. Dedicated advisors, national cohort events, and monthly webconferences all facilitate networking and idea-sharing.
Best practice research and Web-based education
Members gain access to rigorous research, education, and web-based training on revenue-cycle best practices culled from the most sophisticated and progressive hospitals and health systems.
Contact us to learn more about Payment Integrity Compass
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