AppealsPlus

Denials and underpayments are revenue cycle issues that indicate a provider’s inability to comply with payer requirements, or a payer’s inability to accurately pay a claim. AppealsPlus offers a web-based tool to identify and appeal underpaid and denied claims. It automatically analyzes ERAs, applies rules, and utilizes dashboards and key performance indicators for quantitative management. This Software as a Service (SaaS) technology enables rapid deployment without capital expense, ensuring immediate return on investment.

AppealsPlus improves your denial management around these key areas:

• Filtering – what denials are real and workable
• Reporting on denial categories to help prevent future denials
• Forms and letters – automation and standardization
• Process library – automation and standardization for responses to specific denials
• Payer table – centralized and updated
• Staff productivity – track progress and results
• Advanced reporting results and tracking by denial, payer and time

Our solution provides the mechanism for managing the complexity of the appeals process, allowing the process to evolve over time and emerge as a new leaner process based on simple rules and operational performance. To learn more about AppealsPlus, contact us today at 833.943.4427 and read additional information here.

SCORE

SCORE (Systematic Compliance Optimizes Revenue Efficiency) is a Revenue Cycle Compliance service offered by GBS to assist Clients in:

• Identifying and correcting compliance issues
• Reducing risk of fraud and fines
• Achieving an optimal increase in revenue

The initial analysis focuses on a hospital or physician group’s financial health, compliance status, and earned revenue. The Analysis Report identifies compliance issues and suggests a “Compliance Audit of the Client’s Charge Description Master (CDM)” to increase total patient revenues. SCORE helps identify and correct compliance issues to avoid fines and accusations of fraud by CMS’s Recovery Audit Contractors.

Recently, the need for continuing maintenance of the CDM has become increasingly important due to payer contracts’ complexity, scrutiny, and mandates for transparent pricing. Failure to maintain the CDM accurately places a facility at risk for compliance violations and lost reimbursement. The focus has shifted to the accuracy of all CDM line items. Ongoing analysis of the CDM is necessary to ensure the proper combination of coding and revenue for each charge. SCORE resolves these issues and ensures the integrity of the client’s revenue stream, leading to the identification of significant additional revenue. For more information on SCORE (Systematic Compliance Optimizes Revenue Efficiency) and how GBS can help ensure revenue integrity, contact us at 833.943.4427 or open our informational piece here.