Are you experiencing clinical pre-bill and/or denial backlogs?
Medical necessity is our specialty – throughout the life of cases and claims, from referral-to-reimbursement.
ADVENT’S SPECTRUM OF SERVICES
Advent’s provider solutions minimize denials and underpayments, improve patient access and eligibility verification, increase patient collections, improve medical coding accuracy, and maximize compelling appeals for managing denials. Our team is well-positioned to assist you in achieving timely and accurate reimbursement while reducing your operational expenses. We deliver expertise across:
Our inpatient appeals always include a clinical argument – no matter why the claim was denied in the first place. Applying our clinical expertise on the front-end helps minimize the need for additional appeals.
Not all outpatient claims are created equally. Advent strategically focuses on certain types of claims, which helps our clients recover more revenue from outpatient denials.
Health plans expect providers to perform a coding review on DRG downgrades. We know that a clinical review of a DRG downgrade demands attention from health plans – and increases overturns.
We help hospitals and health systems:
- Overcome clinical review backlogs across the continuum of care in both pre-bill and post-pay spaces.
- Identify process improvements to help ensure correct authorizations/timely filings – and ultimately improve clean claim rates.
- Improve vendor performance since an increased clean claims rate equals fewer outsourced claims.
- Enhance health plan communications with additional bandwidth provided by the Advent team or technology platform plus our recommendations for communications process improvements.
Our expertise spans decades of working with multi-level providers and multi-lines of business with health plans to build revenue integrity while minimizing obstacles to timely, appropriate reimbursement.
Trend ERA and EOB data to evaluate recovering dollars more quickly
Utilizing sensitivity analytics is a key driver in determining the profitability of health plan contracts. Additional tools that prove effective when evaluating health plan contracts include:
- cost to collect,
- carve outs,
- timely filing limits, and
- net revenue.
If you’re ready to work with us but not sure where to begin, we recommend starting here.
BENEFITS OF CHOOSING ADVENT FOR CLINICAL PRE-BILL AND/OR DENIAL BACKLOGS
Our team includes doctors, nurses, coders, and claims analysts with experience in medical necessity, inpatient/outpatient, and severity of illness.
We’ve worked for – and with – many health plans, enabling us to align cases with contracts and guidelines.
Partner based on your current needs, including: staffing, new regulations, and target area (e.g., health plan, claim type).
Based on organizational goals, choose your reporting by specific claim, and/or by aggregated process improvement trend.