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Denials Management Services

Minimize Claim Rejections and Sustain Revenue

Financial executive for a hospital, health system or employed practice, know medical billing rejections are constant nuisances they negatively affect organization’s revenue, cash flow and operational efficiency. As refusal rates increase and compliance becomes more complicated, revenue cycle leaders must constantly tackle the causes of issues that prevent cash flow.

Relieve Team of the Load of Denials and Backlogs

The numbers inform the story. One out of five medical claims has to be reworked or appealed, but staff members are overburdened precedency projects and unable to address most refusals – yet when denials are appealed, success rates can vary from 55-98%. Present’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 revenue.

Objectivity is that many medical billing denials can be minimized, remake and appealed successfully with a third party like WRC addressing them on organization behalf. WRC helps organization reduce a backlog of administrative and clinical denials and address upstream coding or editing problems to minimize future denials. We contact payers on organization behalf to dispute discrepancies, underpayments, and chase a quick resolution. WRC stays on top of constant payer follow up that may take months, which means Organization don’t have to hire additional coders or staff.

A Refusals Management Group That’s On Organization Side

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

Refusals and Underpayment Recovery

Full outsourcing of your denials resolution procedures, performing focused audits, our denials management command can offer much help as Organization need to maintain control of financial performance.

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

Audit Services

WRC help Organization manage payer audits from commercial and government payers, including third-party defense audits

  1. RAC Audits and Other Payer Audits: WRC 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.
  2. Documentation Requests and Appeals: By coordinating the process of medical chart reviews and submitting appeals within specific time frames, WRC relieve the administrative load from staff in the patient financial services, case management and health information management departments.

Constant System Edit and Workflow Maintenance

WRC expertise guide your organization to realize appropriate edits and workflow modifications designed to address ongoing regulatory, payer and industry changes.

  1. Administering, Payer and Industry Compliance: WRC staying abreast of regulatory changes in the industry, reviews and implements payer bulletins and changes, provides educational tutorials to staff. WRC investment in staying on top of constant regulatory, payer and industry changes helps your organization achieve a refusal management approach.
  2. 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 Organization behalf, WRC can stay on top of ongoing edit maintenance and cleansing in Organization system in order to keep claim submissions and cash flowing smoothly.

Detailed Reporting

WRC produce detailed reports that give insight into the processing and resolution of denials, underpayments and audits.

  1. Trending: Providing a report, WRC 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.
  2. Payer Contract Negotiations: Refusal and underpayment trends, insights provide your organization with information needed for upcoming payer contract negotiations.