services for hospitals and medical facilities

Hospitals have become the front line. 1 in 5 doctors has been furloughed or taken a pay cut as the coronavirus pandemic hits hospitals. You have revolutionized your day-to-day operations to save lives and you have done a wonderful job. We appreciate it. Who is helping save your main lifeline: revenue?

You do what you do best, which is provide care. We want to help you by doing what we do best: we can help you collect your hard-earned money. Many hospitals that we have worked with in the past have had issues that extend beyond basic Clinical Documentation Improvement and Compliance but more into perfunctory payer denials of valid claims. We have experienced clinical coding professionals who work directly with our clients to make a customized solution. We are not the one-size-fits-all consulting company that looks to land a client and stay there for a while. We efficiently work with our clients as a trusted partner when we are most needed. Proactively developing plans and methodologies to avoid denials rather than just helping fight them.

America’s hospitals are committed to quality patient care and take compliance very seriously. Yet, necessary care payment denials are common and amount to thousands of dollars in lost costs, further aggravating the widespread operational problems. With our proven solutions and real results, Advize Health is a trusted provider of medical review services for the nation’s most prominent hospital systems. To help you focus on superior treatment and care for your patients, we supply you with first-class consulting, auditing, education, and coding support services to help you recoup costs. Our services include:

Denials

Payers use more Artificial Intelligence which causes and contributes to higher denials. The inability to overturn incorrect and/or questionable payer rejections can become expensive to providers. Appealing to your insurance company takes time and requires intricate clinical documentation requirements and standards understanding and knowledge. Additionally, denials are costly to resolve, on average, $118 dollars per claim to appeal.

Denial write-off adjustments average 3 – 4% of net revenue, which equates to $262B in initially denied claims for healthcare providers annually. Further, 1 in 10 claims was denied at an average 350-bed hospital and $1 out of every $5 of revenue cycle management (RCM) expenses are attributed to denial-related issues.

We utilize highly proficient, seasoned clinical auditors who are skilled at reviewing appeals and can help you immediately by driving much needed revenue and enhanced cash flow. Without adding stress to your team, we review and evaluate records and help you respond to the insurance company.

To get started, we will take a precursory review of your denials, this is complementary. Within a week, we will develop a plan and low-cost solution for your team to add directly to your bottom line. Contact us now to learn more.

Audits

  • Remote coding audits and remote coding for inpatient visits, outpatient surgery, emergency room, injection/infusion, and ancillary records
  • Onsite coding support and education for injection and infusion coding and updates
  • Policy and procedure review and audits

Existing Programs

  • A comprehensive review of current policies and procedures to identify opportunities
  • Support to improve current procedures to leverage opportunities
  • Customized training for staff and ongoing support

New Program Development

  • Assessment of current procedures
  • Suggestions on implementation of improvement plan and perform training
  • Providing ongoing support and follow ups