Retained & Expended Revenue Optimization

The Revenue Optimization team at HealthUnits strives for excellence and works to keep your revenue elevated, ensuring maximum employer satisfaction. We review modern procedures from various perspectives to identify numerous ways to increase revenue. Our team thoroughly evaluates the entire revenue process, adhering to state regulations. By examining demographic entry, medical record decoding, claim submission, payment posting, and denial management, we build strong relationships with our clients' staff. We devise and implement plans in both front and back offices. Successful implementation leads to boosted cash flow and optimized revenue.

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

HealthUnits Strategies for Optimal Revenue Maintenance:

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.