Why ClaimCure?

Aging Accounts Receivable

Unfair Payment Practices

Late Reporting

These three headaches all share the same solution: ClaimCure.

Our services are tailored to help you organize your billing procedures and give you peace of mind.

Your Ability to Practice Medicine is the Direct Result and Product of Cash Flow!

Our Services

Revenue Cycle Consulting

We partner with you to improve processes and denial management to maximize your cash flow.

ClaimCure consultants are ERN Certified Compliance Consultants skilled in health administrative laws to prevent unfair payment practices and negligent utilization reviews. We bring together administrative laws across all jurisdictions (including MA, HMO, PPO, Medicaid, ERISA, and VA) with process improvements and denial management to accelerate cash flow, decrease and prevent denials.

ClaimCure consultants will observe your FTEs in the front, mid and back end of the revenue cycle to gain a complete understanding of your existing processes, and most problematic denials. Then we will analyze the processes to determine areas for improvement, as well as where and how administrative laws can be integrated to reduce avoidable losses and accelerate collections. We then provide a detailed implementation guide with findings and recommendations, along with tools for implementation. Services we provide:

• Customized policies and procedures in the admissions, authorization, transfer and appeal process.
• A denial management strategy and roadmap.
• Claim resolution on high dollar accounts.
• Training of revenue cycle staff on how to implement administrative laws to fight and prevent denials.
• Metrics and flow charts.
• Documentation and rebuttal scripts to increase cash flow.
• A library of documents and forms with integrated administrative laws such as UM fax cover sheets, appeal and demand letters, law appendices.
• Payer-provider contract review and analysis with recommendations to decrease administrative burdens, increase net revenue yield, and reduce avoidable losses.
• Strategic consultations on specific denial issues.
• Specialized template appeals and fax cover sheets for specific issues identified.
• Onsite or remote consultants to work as an extension of your revenue cycle team.

Pre-litigation Revenue Cycle Consulting

We partner with you to determine the next steps for unresolved accounts.

ClaimCure consultants can assist in determining what the next steps should be for accounts where appeal and collection efforts have been exhausted. We can review and analyze the accounts to determine if there are unfair payment trends that should be escalated to regulatory agencies based on administrative laws; Review and analyze accounts along with provider-payer contracts to determine if litigation should be considered; and assist in preparing cases for litigation. Services we provide:

• Claim denial root cause determination and analysis in conjunction with health administrative laws and provider-payer contracts.
• Unfair payment trend analysis and reporting for regulatory complaints.
• Pre-litigation analysis and recommendations on unresolved accounts.
• Document collection and review for litigation.
• Case materials/evidence preparation for litigation.
• Expert witness services.

ERN Onsite Compliance Audits and Consulting

Providers typically miss appeal positions and revenue opportunities in their Business Office and Patient Access Departments. Considering the many handoffs and steps to stabilize, request authorizations, admit, treat, document, code, and bill each patient, oversights can be frequent.

Using our unique onsite process, ERN can help. Most of our engagements identify revenue opportunities and develop powerful enforcement campaigns maximizing monthly revenue from at least $150,000 to $50,000,000.00 per project. Service areas offering the greatest potential for improvement include emergency admissions, poststabilization authorization/transfer protocols and medical necessity and surgery denials.

You will get:

• An ERN Certified Compliance Auditor skilled in administrative laws to prevent unfair payment practices and negligent utilization reviews.
• A detailed implementation plan with specific payor corrective action plans and recommendations.
• A library of regulatory documents and forms (affidavits of compliance, appeal and demand letters, law appendices, etc.)
• Continuation of monthly offsite audits (remote access by our team of experts to provide solid guidance for your PFS/case management team in the preparation of appeal positions and letters.)
• Customized policies and procedures in the admissions, authorization, transfer and appeal process.
• Patient/Provider hotline to refer disagreements of care and untimely authorization cases to our Intake Unit.

To schedule an onsite audit or in service visit, call (714)995-6900 ext. 6925

Benefits of ClaimCure

Denial Prevention

Maximize your recoveries and minimize assignments to third party agencies with ClaimCure’s proprietary claims payment compliance letters and process.

Deliverables

Improve your fiscal health. Track reimbursements and outstanding payments with dozens of standard and hundreds of customizable reports.

Enhanced Consistency

As a division of ERN/NCRA, ClaimCure is staffed with healthcare policy professionals, who are seasoned with claims compliance and navigating the regulatory system. ClaimCure also guarantees year round appeals-process handling and a consistent level of claim turnarounds. Our standards of success are unmatched.

Compliance

ClaimCure consultants are ERN Certified Compliance Consultants skilled in health administrative laws to prevent unfair payment practices and negligent utilization reviews. We bring together administrative laws across all jurisdictions (including MA, HMO, PPO, Medicaid, ERISA, and VA) with process improvements and denial prevention to accelerate cash flow, decrease and prevent denials.

Continued Education

Our consultants are provided with continued education materials and receive updates regularly from Medicare and Medi-Cal. Investigation and research are important details in assuring ClaimCure is up to date on all changes in the healthcare industry, resulting in a continuous cash flow.