The Changing Financial Landscape
The worldwide financial crisis has forever changed the way hospitals will do business, forcing hospitals to examine every process, every mechanism, to realize net revenue for the hospital. Institutions can no longer afford to continue sustaining write-off levels.
Missing authorizations and subsequent denials can account for significant portions of all payer-denied claims, and can result in a loss of 3%-5% of your hospital's net revenue. Your hospital can't afford to lose net revenue because of the patient volume, complexity of payer rules, and time constraints related to the manual authorization process.
Recondo Technology believes as much as 90% of claim denials may be preventable through improved up-front execution of verification and authorization.
Auth-DP Automates Authorization Management and Reduces Denials
Authorization-Denial Prevention (Auth-DP) allows your patient access staff to identify whether an authorization is required, and the status of that authorization, prior to service, ensuring that you provide service only with the approved authorization in place.
Missing or incorrect authorization information causes hospitals to write off millions of dollars every year. For many hospitals, claim denials represent the greatest financial challenge across the revenue cycle. By reducing authorization denials, revenue cycle management teams can redirect staff members to focus on other areas of the revenue cycle.
Auth-DP uses high-speed, high-volume rules processing to capture and display Authorization approval, signaling staff when an authorization doesn't exist. The hospital can then access payer portals and obtain necessary authorization, eliminating the possibility of a claim denial.
Auth-DP from Recondo Technology
Auth-DP is the newest Software as a Service (SaaS) offering from Recondo Technology. Auth-DP complements the Recondo SurePayHealth® product, further streamlining revenue cycle operations from the accurate statement of patient financial responsibility presented prior to service to seamless authorization approval, driving down costly denials.
Using high-speed, high-volume rules-based architecture, Auth-DP provides an intuitive, easy-to-use, web-based tool incorporating payer-specific rules to guide patient access staff through specific authorization or precertification requirements.
Key Benefits
Identifying and managing every payer's authorization or notification requirements create a challenge even for the most experienced and skilled revenue cycle veterans. Health care providers spend an inordinate amount of time and resources trying to understand and manage all the complex payer rules and requirements. Failing to manage compliance to those rules creates denials that result in significant loss of net revenue.
United Healthcare – Admission Notification
As United Healthcare continues to move forward rolling out their admission protocol related to inpatient notification, Auth-DP supports this initiative for those hospitals utilizing the 278N. Automating the 278N process with Auth-DP can eliminate a hospital's exposure to payment penalties due to untimely notification.
Medicare's Medical Necessity and ABN (Advance Beneficiary Notice)
Similar to the evaluation done for commercial or managed care patients, Auth-DP determines Medicare's Medical Necessity based on a procedure and associated ICD-9 diagnosis code. If it is determined that the procedure does not meet medical necessity, Auth-DP produces a standard ABN.
Auth-DP Features
Intuitive User Interface
The logical design and flow of Auth-DP comes directly from hospital staff who have spent years on the front lines of the Patient Access department. The Auth-DP portal is designed to model industry-standard registration processes.
Collection and Management of Patient Data
The integrity and validation of patient data on the front end sets the stage for successful authorization management processes. Building on the eligibility strengths of other Recondo services, Auth-DP ensures improved patient data and eligibility verification.
Procedure-specific Assessment
Auth-DP captures and determines whether an authorization is required on a patient type and/or procedure basis based on the evaluation of payer and contract-specific rules
Auth-DP helps hospitals:
- Decrease denials and denial write-offs
- Accelerate cash flow
- Increase net revenue
- Minimize bad debt
- Reduce A/R days
- Optimize resource allocation
- Improve patient satisfaction
Status Management
Auth-DP notifies patient access staff if an authorization is on file; if not, Auth-DP helps staff retrieve an authorization number or status from payer portals.
Control Center Worklist and Reporting
Many stakeholders need access to up-to-date authorization status to take appropriate and necessary action to ensure authorization and approval. The Auth-DP Control Center Worklist assists with global authorization management and aids in prioritizing exception management.
Software as a Service (SaaS)
Auth-DP is Software as a Service (SaaS), deployed using only a browser. Your hospital doesn't have to plan for a capital expense or install any additional hardware or software.
Find out more about the Revenue Cycle Solutions offered by Recondo Technology
The other Recondo software services, SurePayHealth and EligibilityPlus, help hospitals across the US deliver an accurate statement of patient financial responsibility at pre-registration or at point of service. SurePayHealth calculates the patient fee based on the hospital chargemaster and managed care contracts, and verifies patient identity, eligibility, and benefits. EligibilityPlus provides access staff an Enriched Benefits Inquiry, which includes all the specific benefits necessary to accurately assess and complete eligibility and benefit verification.
Recondo Technology is the only vendor offering a complete solution to health care providers for managing payerspecific authorization requirements. No other vendor has taken on the challenge of delivering a service specifically designed and created for up-front authorization management of both inpatient and outpatient medical services.
Contact Recondo Technology today to see how Auth-DP can help you reduce denials and increase net revenue.
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