Frequently Asked Questions
What does Medlinks Cost Containment Inc. do?
In our corporate evolution, Since 1997, Medlinks has been involved in the healthcare industry as an expert in the area of Hospital/Provider Defense Management Solutions. This includes commercial reviews, DRG, coding and billing, and RAC reviews. Our specialty is the complete outsourcing of hospitals denials management department and includes:
- Coding Denials (All Types) – Using our patented SaaS application/tool Claim WRX, we will “custom fit” our reports to your specific needs. We use TruCode as our encoder but can easily create your custom reporting in your encoder and then push that data to Claim WRX for tracking, management, and reporting.
- Clinical Appeals (All Types) – Our process, methodology, and using Claim WRX, we approach this “critical” area of denials first by moving your denials forward towards resolution. Second, we are focused on using all the tools to win your “hard earned” dollars back. Finally, while addressing your tough work, and winning your dollars back, we are going to capture the “story” of your denial, appeal, its root cause, its fiscal impact, and so much more.
- Line-Item Claim Review/Audit (All Types) – Claim Reviews and Audits have changed dramatically in their approach AND more importantly in their interpretation of the rules. To win here, you need to be knowledgeable and tough. Your giving dollars back that you do not need to.
What industries do specialize in?
Medlinks specializes in the healthcare industry. Medlinks has worked for hospitals, payers, self-pay insurers, physician practices, chiropractors, law firms, and any other specialty within the healthcare industry. Our specialty is helping you contain costs within your practice. Medlinks also provides staffing for:
Third Party Administrators
Financial Institutions Business Offices Information Technology Executive Recruitment and more…
Do we really need an audit plan?
Of all the interventions Medlinks could possibly bring to your practice, there is likely none more important than an audit plan/policy that addresses the losses and potential losses associated with audits at your site. In the realm of hospitals and payers these losses number in the many millions. It is crucial to not only have an audit plan but policies, procedures, data analytics, and a process for bringing it all together. This is where Medlinks and Claim WRX shines! Take control of the onslaught with our exclusive Denial Policy.
What makes your denial management special?
Medlinks brings a multi-pronged approach to your denials defense. That approach begins with an audit plan, an audit policy, a data analytics tool called Claim WRX, and a “boots on the ground” approach where we get on-site, talk to the people that are pertinent to the problem and start to eliminate your losses. Simple and effective.
How does the process work?
Medlinks will start with a site/vulnerability assessment. Whether that information be gathered remotely or on-site Medlinks will do an assessment of your current audit practices and how those practices may be improved.
The most common theme seen is a compartmentalization of denial management. In other words, many sites/firms do not consider keeping all their denial data in one analytical location. Medlinks Claim WRX tracks defense audits, government, and commercial audits, DRG, coding and billing, clinical appeals, and even internal reviews for self- compliance. Then when your CFO says, “what’s the situation with denials?” This fully encompassing process lets you know from one source where your risks and your losses are occurring. The delivery of custom-made reports is an easy click.
How long does it take to recover my denied dollars?
Denials and Denial Losses, and in fact the entire industry of healthcare denials is based on motivation. Payers are motivated to deny especially at sites that do not have an aggressive defense plan. Do you have a defense plan, is it updated, do you have a monthly Denials Committee Meeting with required attendance by your c-suite and directors? With Medlinks the answers will be yes, we will even chair your denials meeting. Our singular focus is your denials.
How long it takes to eliminate denial losses will depend on several key factors. These will be your own sites motivation to stop these losses, your site’s ability to effectively communicate, and the depth at which you allow Medlinks to operate within your facility with departments such as administration, contracting, and your managing directors. Let us show you this recipe and metrics that it has been working since 1997.
Will you agree with everything I say?
Like a healthcare practice has a style and a rhythm so do many facilities. Medlinks as well has a style and a rhythm to our audit philosophy and while flexible to your needs, we feel as though we are the experts in healthcare denials and its many nuances. One thing we can all agree on at the end of the day is that a solid approach to audit defense will contain, and reduce, or eliminate your losses. Not only that but it will highlight the “motivations” or root causes motivating your next denial. Make those go away and denials go away.
How do you price your services?
Medlinks pricing of a facilities true needs, requires an assessment. If the needs are small, we may set a small stipend along with a per audit fee. If your needs are many, we would determine the number of individuals and time required, usually based on the dollar amount of the claim, the number of admitted days, and etc. We have a variety of flexible plans, and most are custom fit.
Is Medlinks worth the money?
Compared to the losses you will incur in denials and the potential loss in compliance, we are an absolute bargain! How can we say this? We are going to get into the trenches (Your EHR Work queue) and reduce your losses within 7-17 days. We are going to “track” that data and tell you the “story” of your denials one by one and taken together. Over time as we address the obvious and then the not so obvious, all the while toughening up your internal process, we will reduce your losses. Medlinks can provide you with reports (free of their PHI) from locations/firms/sites where we have nearly eliminated their losses which began in the millions per year.
Will I sign a nondisclosure agreement?
Yes. Medlinks developed Claim WRX in 2011. This cloud-based tool is a proprietary tool that you will either use at your site or we will use at your site. Medlinks also openly and freely shares ideas, processes, documents, and other intellectual property that requires a signed NDA.
Can you send the samples of your work?
Absolutely! Not only can we send you example reports were happy to demo the Claim WRX and discuss our denial’s philosophy at your location. We are happy to demo our application/tool and services online which takes about an hour, or were happy to come on-site. Visit the home page for a copy of our FREE Audit Policy.
Where are you located, and how do you work with clients outside of your local area?
We are in California about an hour east of San Francisco California. We have worked as far away as North Carolina, and we often do national HEDIS auditing which has taught us the value of VPN, terminal connecting, and national flexibility. We’ve hired hundreds of nurses across 30+ states. Your location is not an issue for Medlinks. We will come to you digitally or in person as you wish. We believe on site engagements are effective. We also do Nursing Update Seminars with regard to “documentation, documentation, and documentation.”
Under what circumstances does it make sense for us to hire you?
- If you are losing any money at your site based on denials or compliance, Medlinks can reduce or eliminate those losses.
- If you want to reduce/eliminate employee costs
- If you want an ever evolving, keeping the pace firm
- If you want reports and data that is “served up” in an Executive Level Reporting fashion
What do we need in order to start?
Medlinks services would require an assessment, a contract, and an on-site or tele visit.
What are your qualifications?
Among our many talents, Medlinks has access to highly qualified medical auditors/appealers/coders. Many are nurses, many NCQA, CMAS, and coding certified. While we may tout qualifications, our primary goal in hiring this staff is talent! There are plenty of qualified individuals in the world but in our practice, we value talent and auditors who think creatively. Our job ultimately is the aggressive defense of your hard-earned dollars.
Do you have references?
We certainly do! As you can see by some of our testimonials, and the fact that we have been the outsourced audit department for some sites for more than a decade, it is clear to us that in the eyes of our clients we are highly valued.
Some of clients have been and/or are:
Wahington Hospital Health Systems
Stanford Medical Center
Sutter Health Systems
Anthem Blue Cross
County of Fresno
Sutter Shared Labs
John Muir Health
El Camino Hospital
Moses-Cone Medical Center
New West Health
City of Long Beach
Law firms (multiple)
What’s the origin of Medlinks cost containment name?
In 1997 we began as Medlinks. The origin was intended to show that we were a medical link between the needs in the healthcare community and our ability to meet those needs.
In 2001 Medlinks became Medlinks Cost Containment Inc. and at this stage we realized that our value was not so much in the links we could provide but in the “cost-containment” that we were and continue to provide.
In 2011 we developed Claim WRX and in 2015, we formed Medlinks Staffing, LLC., an offshoot of Medlinks Cost Containment, Inc. This evolutionary trajectory has served to “position” us perfectly NOW to meet your needs and stop your painful denial losses.