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Delivering Solutions to Healthcare Organizations
Revenue Cycle Management Solutions
Healthcare providers and facilities partner with HeW to achieve their revenue cycle management goals. As shown in the HeW Revenue Cycle Management Solution chart, these solutions include various processes throughout the revenue cycle that create more efficient business processes, reduce A/R days and increase reimbursement opportunities.
By assessing and understanding patient benefit entitlements, HeW clients experience fewer denied claims, reduced A/R days and an enhanced patient account management process. HeW clients can validate patient eligibility prior to admission, or rendering services, through the following methods:
Real-time eligibility verification is available by accessing benefit information through HeW’s browser-based application by receiving responses to electronic eligibility inquiry transactions from select Health Insurance Carriers. The level of detail available in these transactions is determined by each Health Insurance Carrier.
Batch eligibility verification is a custom solution available that enables clients to submit a patient roster from their host system and receive updated eligibility information for those patients prior to rendering services. HeW clients can receive eligibility data in a customized format to review or upload to their host systems.
Custom interface eligibility verification is a custom solution that interfaces with the clients host system to verify patient eligibility within the host system.
HeW clients achieve their revenue cycle management goals through the use of the HeW claim management software, ex12. ex12 is a HIPAA compliant, browser-based application that is compatible with any Practice Management or Hospital Information System. It securely transmits primary, secondary and tertiary claims, allowing HeW clients to manage claims from the point of submission through adjudication. ex12 is a customizable environment, enabling clients to meet their specific workflow and business environment needs.
HeW simplifies claim management processes by offering custom coding, or scrubbers. These scrubbers eliminate repetitive errors or constant conditions, thus reducing the manual effort involved in managing claims. Scrubbers also significantly reduce the number of erred claims, improving first-pass rates and reducing claim denials.
HeW provides a robust suite of transactional edits to ensure clients achieve high first-pass rates. The HeW editing suite includes validation of transactions against the following policies and standards:
- HIPAA Levels 1-7
- CCI
- NCCI
- Medicare NCD & LCD
- Custom payer edits; such as duplicate claims checking
HeW monitors payer rejection reports to identify additional edits that can improve revenue cycle processes. Clients may request custom edits, giving them the flexibility to meet the specialized needs of their organization.
HeW has connectivity to nearly 2,000 Health Insurance Carriers and Trading Partners. To ensure the most rapid transmission route possible, HeW continually pursues exclusive arrangements and direct connectivity with payers most predominantly used by clients. Transactions are transmitted daily are reconciled to ensure they have successfully reached their destination.
HeW clients have the ability to track claims through the adjudication process using Claim Status Inquiry transactions, reducing lengthy follow up calls to Payers. This service enables HeW clients to more quickly identify delays or rejections in the adjudication process, promoting accelerated payments and greater staff efficiency.
HeW clients are able to receive Electronic Remittance Advice (ERA) from a variety of payers. ERA provides payment information much more rapidly than traditional paper alternatives. Clients can download, post, view and/or print payment information available within the transaction. These features allow clients to select the most efficient ERA process for their organization. HeW clients may also use ERA payment information to rapidly bill secondary claims and track denials.
HeW provides several secondary billing solutions that allows clients to choose the most efficient option for their business office. Using ex12, clients may coordinate benefits by entering, uploading, or auto-posting ERA files to create secondary claims. At the click of a button, these options enable HeW clients to bill secondary Health Insurance Carriers electronically. Resulting in, improved revenue cycle performance with accelerated payments and reduced A/R days.
HeW provides clients with tools to assess and manage claim denials. Using ex12 clients can easily identify and correct rejections, allowing for rapid resubmission. HeW clients have the ability to identify and correct both front-end errors and back-end rejections. Using these tools, scrubbers can be identified to reduce errors or billing process adjustments can be identified to reduce rejections. Utilizing HeW Denial Management Solutions, clients are able to prevent future denials, in turn accelerating reimbursements and improving A/R days.
In this ever evolving industry HeW understands it is critical for clients to continually seek ways to improve office efficiency, reduce denials and accelerate reimbursements. HeW helps clients achieve these goals by providing a number of standard and custom reporting capabilities. HeW Analytical Reports include valuable information regarding staff’s claim management practices, including denial reasons or claim counts. HeW can also develop Custom Reports that more specifically meet individual client’s management needs. The depths of HeW reporting capabilities are endless.