SurePayHealth® helps hospitals and clinics accelerate collections and control the revenue cycle.

Increasing Point Of Service Cash Collections

More patients are presenting for service with highdeductible commercial health insurance or Consumer- Directed Health Plans (CDHPs) or high-deductible Health Savings Accounts (HSAs). Recondo Technology offers a unique approach for helping providers calculate and present an accurate statement of patient financial responsibility at Point of Service, and collect that money prior to service.

The Recondo® SurePayHealth (SPH) service accurately calculates how much of the statement is owed by the patient and that calculation is available to the provider and patient before care is delivered. SurePayHealth provides the calculation and statement in real-time and is fully automated.

Reduces Bad Debt and Write-Offs

Today SurePayHealth is helping hospitals and other providers across the US to verify patient identity and insurance eligibility, and to calculate an accurate patient statement at Point of Service. By ensuring data quality on the front end of the revenue cycle, hospitals can reduce back-office rework as well as full time employees (FTEs) required to manage bad debt and write-offs.

The above summary is a SurePayHealth statement, which has been de-identified according to HIPAA requirements. SurePayHealth generates and prints a complete, accurate, and easy-to-understand patient statement, detailing the patient’s financial responsibility.

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The SurePayHealth result: collect more cash, reduce bad debt and write-offs, and increase your hospital’s profits.

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How Does SurePayHealth Work?

SurePayHealth processes both scheduled and non-scheduled patients through the service, and calculates the patient portion of the bill. The Recondo Revenue Cycle services team loads your patient schedule file, chargemaster, commercial payer contracts, claims history, and master patient index (MPI) into SurePayHealth.

Because SurePayHealth has the industry’s most extensive real-time link to payers—more than 400—and harnesses Electronic Data Interchange (EDI), webbots, and AutoCall features, the service generates a statement with an accurate calculation of patient financial responsibility, including:

• patient eligibility
• co-pays
• plan benefits
• co-insurance
• YTD deductibles
• YTD out-of-pocket status and limits

The SurePayHealth Control Center Worklist offers a wide variety of standard and custom reports to measure operational volumes, amounts, patient activity, manage exceptions, and more.

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SurePayHealth has the industry's most extensive real-time link to payers including Wellpoint, UHC, Aetna, Cigna, BCBS, and Humana, and many more.

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The Recon Loop

SurePayHealth, an "intelligent" service, learns as it processes more patients. The SurePayHealth Reconciliation Loop (Recon Loop) is the technology behind the service's exceptional capability. The Recon Loop features technology and processes that reconcile all the data elements of every hospital business transaction to learn from any discrepancies, inconsistencies, or “hidden” rules stored within payer contracts.

The Recon Loop checks final, adjudicated claim data, including statements of patient financial responsibility, claims history, and remittances against prior transactions, updating each record with the reconciliation information. The Recon Loop allows SurePayHealth to “learn” by keeping the rules set and the database current with final, adjudicated, reconciled data.

Subsequent transactions then draw upon newly learned information residing in SurePayHealth. For example, some payer plans include rules specifying a deductible for certain procedures, even after the patient has met the stated plan deductible. Recondo loads the Explanation of Benefits and the adjudicated claim, discovers the “hidden” deductible rule, and applies that rule to any subsequent procedures that apply.

SurePayHealth Immediate Value

As soon as a hospital elects to use SurePayHealth, Recondo experts gather the 837 Claim Submission and 835 Claim Payment Electronic Data Interchange (EDI) transactions and load them into the SurePayHealth rules engine.

SurePayHealth uses those transactions to create analytical reports showing the payer mix, accuracy of claims submitted against claims paid, as well as of analytic claims reporting.

Unlike other analytics services, SurePayHealth takes 837/835 transactions in any format: EDI, other electronic file(s), embedded in emails, or paper copies. Recondo can quickly load these various formats into the SurePayHealth rules engine and immediately create useful and meaningful reports.

A SurePayHealth graphic generated from your 837/835 data, showing your hospital's revenue by payer.

A SurePayHealth graphic generated from your 837/835 data, showing your hospital's reasons for denial.