Advanced Revenue Cycle Analytics: An Overview

2011.9.6 insurance-stress-billerTo be reimbursed for the services practices provide, proper medical coding is required for insurance claims to be accepted.

Medicare, Medicaid, and all private carriers each have separate rules about what they require in certain circumstances. HIPPA has been working to fix this problem, but many White Plume clients articulate this has not happened yet. Offices have to remember inthis particular scenario, atthis particular location, withthis particular payer,this is required to be reimbursed appropriately. Billers and medical coders store that information on sticky notes, in notebooks, or in their heads. White Plume accelerates the process of storage, retrieval, and execution of the information to make sure it is disseminated to the right person at the right time, thereby also accelerating the entire revenue cycle.

From a medical coding perspective, reimbursement rules continue to change and evolve over time. A rule gets changes, a claim gets denied, and a new protocol is necessary for the practice to be reimbursed in subsequent similar encounters. White Plume Technologies provides an accelerated tool to help identify those changes and prevent future mistakes.

White Plume’s accelerated intelligence product,AccelaSMART, retains coding regulations from all of the different geographies around the country, insurance carriers, or even provider specific requirements, to comprehensively review all charge data and make sure it’s coded correctly.

When a rule is changed and a claim has been denied, the practice can look at the situation, understand and digest why it was denied for that particular carrier or group of carriers, and build the intelligence intoAccelaSMART to make sure that it is caught the very next time it happens, regardless of who the user is. WithAccelaSMART you can distribute that information across your practice and protect your revenue cycle.