Transaction Management Workflow

Our transaction management workflow assessment services are designed to assess the current process for managing 835 remittance transactions, denials reporting, and accounts receivable management. Our approach is intended to evaluate the current state of remittance transaction management and identify opportunities to leverage system technology and transaction standards. Doing so will automate and enhance denials management, secondary billing, cash collections, operational efficiency and productivity.

Potential Scope & Approach

The overall objective of the assessment is to identify opportunities to leverage technology to reduce manual intervention, accelerate cash flow, improve revenue capture through timely follow-up, and denials management processes. Our approach includes five key areas of focus:

1. 835 Remittance transaction posting review

Conduct analysis of 835 transaction posting including:

• Posting of Claim Adjustment Reason Codes
• Posting of associated financial transactions, payments and allowances

2. Denial transaction management review

Review and evaluate current state denial reports and process for tracking, managing and appealing denied claims, which includes:

• Identifying denied claims by denial category and process owner
• Assessing financial impact and lost revenue by denial reason
• Identify gaps in reporting and recommendations for improvement

3. Accounts receivable reporting & workflow management

Evaluate the current process for managing accounts receivable balances to include management of:

• Payment Variances
• Patient Liability Balances
• Secondary Insurance Balances
• Denied Claims

4. Assess system functionality to enhance performance

Assess current processes and workflow for managing adjudicated claims and associated accounts receivable balances. In partnership with technology resources; identify opportunities to leverage system functionality to enhance performance in the following areas:

• Account Assignment
• Exception Reporting
• Automated Balance Transfer
• Automated Statement Generation
• Automated Secondary Claim Generation

5. Deliverable

Our deliverable includes findings and recommendations that will enhance Revenue Cycle performance through the use of your vendor system technology and transaction standards. We identify necessary system enhancements to leverage existing technology that will enhance denials reporting, accelerate cash flow and improve productivity and performance within revenue cycle operations. We will provide the following recommendations to:

• Enhance transaction posting
• Enhance denial reporting and trending
• Streamline accounts receivable follow up
• Streamline secondary billing and patient statement generation

Enhance performance through knowledge transfer, process improvement, and technology enablement