The Issue
With more than 1,000 medical centers and clinics nationwide, the U.S. Department of Veterans Affairs operates one of the largest integrated delivery systems in the world. In that capacity, VA is both a patient care provider, serving millions of patients each year, and a payer spending hundreds of millions of dollars on fee-basis care annually.
The U.S. healthcare system has evolved into a complex system where healthcare providers are entitled to reimbursement for services by primary, secondary, and even tertiary payers comprised of Government programs, commercial insurers, and patients. VA serves millions of patients each year, many who are entitled to non-VA healthcare benefits, like commercial health insurance, that go uncollected by VA. At the same time, in its role as a payer, VA often lacks the information and capability to identify claims with other party liability prior to payment, and to recoup any overpaid amounts.
With mounting budgetary pressures and escalating demand for services, VA faces the daunting challenge of ensuring it maximizes efficient use of its budget resources through accurate claims payment and maximized collections for services rendered.
The Solution
Financial Recovery Solutions offers several reimbursement optimization services designed to help VA implement the best practices in revenue cycle management.
Coordination of Benefits represents a significant challenge for all payers and providers—public and private. We help our customers develop, implement, and manage highly effective COB programs through timely and complete collection of patients’ insurance information, analytics to identify COB coordination opportunities, and a structured approach to claim submission, tracking, and resolution.
Claim Audits represent one of the most effective ways of identifying overpayments, underpayments, other party liabilities, and adjudication errors. Our focused audits, DRG validation audits, and chart reviews ensure that reimbursement amounts are consistent with policies and supported by medical records. Using our sophisticated analytical tools we can quickly and efficiently review claims to ensure accurate pricing and identify possible adjudication errors prior to payment. When overpayments are identified, our trained and experienced recoupment specialists can help recoup monies owed.
Denial Management is a necessity in the claim-based reimbursement model. Our Denial Management program helps customers minimize denials through process improvement. Recognizing that even the most efficient organizations experience some denials, we also offer administrative services and specialized tools to help prioritize, automate, and track resubmissions.
Through our strategic network of small business prime contractors and subcontractors, we can help Government agencies satisfy their small business contracting goals, meeting service-disabled veteran-owned, 8(a), HUBZone, Tribal Owned, and small disadvantaged business considerations.
Financial Recovery Solutions offers a variety of customized services to help optimize fee-basis payments and maximize collections from third parties. Our offerings combine implementation of best practices; sophisticated tools and analytics; and trained, experienced staff.
For more information on how Financial Recovery Solutions can help your organization optimize reimbursement and revenue cycle management, contact:
Mr. Matt Biefeld
Director of Claims Oversight
502-301-6524 or
mbiefeld@humana.com
