Retained & Expended Revenue Optimization
Why Our Optimization Program is Significant
HealthUnits proposes its Revenue Optimization Program to address the following issues:
Inefficient Accountability
A robust check and balance system is crucial for maintaining transparency and seamless operations in your practice
Difference Between Charge and Paid Amounts
Large discrepancies between billed and paid amounts can reflect poorly on the billing agency.
Unpredictable Cash Flow
Consistent cash flow is essential for running a successful practice. Technically proficient medical billing is required to ensure smooth cash flow.
Ineffective Claim Follow-Through
Receiving similar denials repeatedly indicates that claims are not being effectively followed up and are being overlooked.
Excessive Denial Rate
A denial rate of 10% or more clearly indicates substandard medical billing practices.
Lag Submission of Claims
Every insurance company has specific Timely Filing Limits (TFL). To avoid denials due to late submission, it is essential to comply with these TFL limits.
Payment Posting Holdup
Delayed payment posting negatively impacts the transparency of practice outcomes and creates difficulties in identifying forthcoming denials.
Excessive Medical Documentation
If payers frequently request additional medical records to substantiate the provided treatment, it indicates that the initial submission was incomplete.
Fundamentals of Optimized Revenue
1. Examining Claims Before Submission:
HealthUnits’ claim production team follows SOPs to check for errors beforesubmitting a claim. These checks include demographic entry, pre-authorization,eligibility and benefits verification, and coding edits.
2. Flawless Submission of Claims:
Once claims pass the initial examination, the HealthUnits team formats the billing form (CMS-1500 / UB 04) and submits claims via EDI format. For payers that do not accept electronic claims, paper submissions are used.
3. Claims Tracking:
HealthUnits tracks claims at every stage after successful transmission. We ensure a primary receipt is obtained from the payer and follow the claim until payment is received. Denied claims are reassigned to the AR Follow-up team for further action, ensuring maximum payment recovery.
4. Account Receivable & Denial Management:
Payments are posted to the corresponding patient accounts. Unpaid and low-paid claims are handled by the denial management team, which fixes and resolves issues before resubmitting them for reprocessing. The AR team negotiates with insurance companies on low-paid claims and sends reconsiderations and appeals.
5. Prerequisite Explorations:
HealthUnits employs analysts who provide feedback on various revenue cycle activities. They identify weak areas needing improvement and track the cycle at each stage, generating multiple reports to show the organization’s exact performance.