Revenue Integrity Services and Solutions

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 and 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?”

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.

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 and 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.

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. We have been in business since 1997.

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.

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.