Revenue Integrity Services
When shopping “denial management vendors” you are going to find a lot of the same “Data” “Tech” and lots of promises that may or may not lead to the rapid, efficient, recovery of your dollars, AND capturing the KPI throughout the “Story” of your denial which can sometimes take years.
Instead of presenting like everyone else, let us do some straight talk. If this dialogue “speaks” to you, let us connect:
Key pain points that Claim WRX solves for my practice/org?
Claim WRX, it is important to note, that this is more than a “tool,” and is a combination of people, process, and technology. That phrase is overused, but applies PERFECTLY in this solution. In fact, which is the secret recipe, and this area of your practice/org deserves this level of attention. The service combines expert staff who are skilled in many different specific areas and along with a platform “Claim WRX,” which is used as a “work management platform” for the resolution and tracking of denied claims and audits. It helps visualize revenue recovery/data tracking of the “denial course “and then produces rich reporting focused on denial root causes in order to make the problem reduce over time. This is cost containment. It also leads to key insights and discoveries as any data analytics platform would claim to. Many of these functions are tracked in a poor way in the professional current healthcare environment, and this opens things up in a whole new way. Over time using this technology and methodology we drive your visibility to crystal clarity regarding why the denials? what are they costing you? and how do we stop them?”
Who within the practice/org does the platform automate this task for and relieve additional work?
Claim WRX has never been an automation play, but rather a platform that along with our staff and methodology, becomes a “force multiplier” for getting the job done more efficiently. It does this by tracking every element of the “story” associated with denials and audits. Why does this matter? Because it is important to know the “story” of a denial, how many levels of denial before it was upheld or overturned, what was the cost in terms of interest paid, cost to defend, and most importantly, what was the “root cause.” And obviously, much, much more, Your “key audience” for this type of cost containment & reporting capabilities would be the following staff and their subordinates; VP/Director of Revenue Cycle, Patient Financial Services, CFO, HIM Director, CEO, Director of Business Office. Subordinate attendees would be Director of Coding, Director of HIM, Auditors, Appeal Nurses, or MD’s, Director of Contracting, and perhaps a Director of Vendor Management.
This Executive Level Reporting is where the people, process, and technology come to full bloom and tell the entire story of all of your denials across Coding, Clinical Appeals, and Audits, all boiled down to error rate. One number. Using that number, we will whittle away at the final percentage points, right next to your staff, communicating as you direct, via an EHR work queue. NO IT integration means we can be in the “foxhole” next to your staff and recovering your hard-earned dollars within 7-17 days. IT Security Review with Remediation? No problem. We can resolve most of these within 5 business days as our security in Salesforce is military grade
Is this a differentiator for us in the market? Do we know if other companies have something similar?
The Platform is the main differentiator. it is built on the Salesforce platform. The differentiators are: No IT integration required for setup other than access to medical records (which is a very secure and common business practice.), SaaS tool built on the Salesforce platform, Military grade encryption set to rapidly pass your IT remediation, Account go “live” can occur within 7-17 days, data can be retrieved from a variety of data sets AND the actual Appeal Letter itself (exclusive to the industry). What does this mean? Client asks to see all appeals for last year containing the word “Cardiomyopathy.” No problem because the entirety of the workflow is contained in Salesforce. What does this mean? It means the root origin of the document is Salesforce. Not Microsoft Word, Not Google Docs, but in fact, built into Claim WRX.
We also offer encrypted email directly from the SaaS application (exclusive to the industry), root cause and error rate methodologies built in as business logic are proven to contain costs in denial management. People are not usually laser beam focused on this one area of concern, but rather Revenue Cycle Management as a whole. We are focused 100% on getting providers and payers paid by doing the tough job of manually settling and appealing denied claims and audits, and we stay in that lane. Because this is what this “lane” requires to recover your hard-earned dollars.
What are the top features and benefits of the tool?
Claim WRX has the ability to track every aspect of every denied claim or audit through the entire process of resolution which leads to discovering and resolving “root cause” issues that are happening as a result of current processes. We also staff the engagements with the right staff for the right types of claims, and have the experience/knowledge to make an impact. In business since 1997.
What type of claims/audits do we address?
There are many, but it boils down to 3 main categories with subsets underneath > line-item claim reviews (audits), clinical medical necessity appeals (clinical appeals), and coding denials (all types). Within this grouping lies most if not all of your denied dollars. Have something unique? self-audits? concurrent reviews (claim is less than X days old)? No problem, Claim WRX has a place for all those unique requests.
Are there any key stats we should be focused on as the client?
There is an example in our resume that shows a client case. Takeaways from that “story” are they the workload provided to us started at ~$97M and worked itself down to ~$6M. ~97.5% success rate in this example that involves auditing work. While our Executive Reports focus on lots of key data and our vendor competition would claim there solution solves all your problems. Our approach is a bit simpler. Thoroughly review the coding, the medical records, the claim itself, know the “rules” to win, use those when possible AND win or lose, bring back to you the client the “Story” of each denial. Then, nothing fancy right? Aggregate and point at the obvious, the source of the denial, its cost, and its cause. We are better at that than anyone else.
What other solutions or services does Medlinks offer?
Contract Negotiation Consultation
Both Payers and Providers can greatly benefit from our contract negotiation consultation service. In the area of auditing and appeals, in particular, Medlinks has offered high-quality consultation to both payers and providers to help them maximize the reach of auditing/appeals/coding and to create a “limit environment” where all claims can be reviewed without hurdles.
Protected Health Information (PHI) Release Management
For many clients, we manage both sides of Protected Health Information (PHI). The release of information or record request management is associated with maximizing your effort to contain costs. With a multitude of ambiguous requests out there, knowing what to ask for and following up on that request can be a daunting task. Many facilities/professionals leave the task of interpreting these requests for records to a junior staffer — often not qualified to know what they are releasing and to whom. Do not take such risks with your PHI! Partner with Medlinks for effective custom healthcare compliance solutions. We use the Claim WRX to initiate and follow up on these requests, assuring you have the records you need, in time, to take
necessary steps if required.
Complete HEDIS Chases – Record Abstraction, Record Research, Record Overread
Working with the HEDIS industry for 12 “seasons”, Medlinks Staffing, LLC, offshoot of Medlinks Cost Containment, Inc., continues to provide nearly 100 = expert remote workers and on-site staff for complete HEDIS chases including record retrieval or pursuit of chases. We provide record abstraction, record research (including re-opening chases for measure compliance), and record over read for total compliance. We have a highly capable project management staff We also have our “only in the industry,” a high-end productivity and quality tracker —the HEDIS Production Tracker — that uses a variety of data points to capture what your staff is doing and ensures that they are meeting YOUR goals.
Claim & Clinical Appeals Analysis — We Provide Payers/ Providers the Tools to Connect
Medlinks Cost Containment provides hospitals and payers with expert analysis of claims and their corresponding need for the clinical appeal. Whether it is about generating an original appeal or defending one, Medlinks record for clinical appeals — done by both our nurses and physicians — has a stellar win rate. Our belief is in a model of education and feedback to the payer/provider to give both parties the tools to connect on a process, standards, and National Billing and Coding Association guidelines. Our clinical appeals team provides Medical Necessity documentation for home health services, Level of Care, DRG Validation, Technical Denial and much more. Using Claim WRX™ we identify “root cause” while we win back your hard-earned dollars.
Payment Integrity Services — A Two-Pronged Approach to Cost Containment
Medlinks Cost Containment provides Payment Integrity services to payers. This is a part audit, part negotiation of claims. This service allows for a two-pronged approach to cost containment. First, it would be an outside view of every claim submitted. This claim submission review gives us a great starting point for a discussion on Medical Billing and Coding online, Contract Negotiation, Cost Tracking, and much more. It also allows Medlinks, and you (the client) define what you will pay for and why. This type of review very often nets dollars, and you only pay when a claim is reduced.
Denied Claim Resolution – Find Solutions to Denied Claims
According to the data shared by the American Medical Association (AMA), in 2013, 7% of paid medical claims had errors. Denied claims averaged about 5% that year. Enter 2022 and lets double those figures and it will continue climbing. Denied claims have many reasons, many of which can and should be appealed. Medlinks expert staff of MD’s and RNs has had remarkable success in reversing these trends. We provide resolutions for a variety of claims, including Workers Compensation Claims, which, let us be very honest, can be very tricky to deal with at times. Their propensity leans heavily towards denial. Our experts can set precedence towards paying claims for the life of the claim. Out of state/country/network presents several challenges, however, we can help or independently navigate these difficult claims for your benefit. Leaning hard into interpretative arguments using Milliman Care Guidelines (MCG), InterQual, Up to Date, Guidance Central and other sources, we working to right the winning letter the first submission.
Zero Balance Audits - Increase Reimbursement and Contain Costs
Insurers today are focusing more on prior authorization and medical necessity. Benefits are more restricted and carve-outs for services, such as behavioral health are more common. More services are subject to deductibles, and in-network and out-of-network coverages are harder to track. Providers must navigate a maze of complex revenue cycle processes, including proper patient identification, registration, authorization management, service documentation, charge capture, coding, billing, and
follow-up. With data analytics and educational follow-ups, Medlinks Cost Containment can help you increase reimbursement, and contain costs.
Medlinks Staffing, LLC
MSLLC is the offshoot of MCCI. Together we can provide a wide
spectrum of services such as:
• Executive Recruitment
• Temporary Employment in the areas of Healthcare/Administration/
Business Office/Information Technology
• Staff Recruitment
Out of State/County/Network
Out of state/country/network presents a number of challenges. We can help or independently navigate these difficult claims for your benefit.
Liability and Lean
Liability and lean can be long fought battles. Let us get these tough to adjudicate claims paid.
Medicaid eligibility is a formal legal process. Correctly processing can be crucial. Let our experts manage this task for you.
Credentialing is a critical part of your sites liability concerns. Make sure credentialing is up to date and correct
Let us bring experts to this critical space
Outlier Overpayment Recovery
Outlier payments are a specialty review worthy of time, effort, and expense. Let our experts get you paid.