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Hospital Insurance Claims Follow-Up and Denial Management Keep your claims from going past timely and reduce days in receivables. Think of us as an extension of your business office.

Healthcare Insurance Recovery Solutions (HIRS)

is part of a line of extended business office services offered to our health care partners. HIRS provides supplemental insurance collection services in a flexible model totally customizable for each client’s specific needs. HIRS provides focused insurance receivable follow-up solutions which ensure the full resolution including confirmation and collection of the payer’s liability and identification and posting of unrealized contracts and adjustments.

HIRS specializes in insurance claims follow-up and denial management on behalf of hospitals and healthcare SSCs (shared service centers) for the full resolution of current and aged governmental and commercial insurance claims.

Our primary goal is to provide experienced and trained personnel to quickly address denials and unpaid insurance receivables in order to accelerate cash flow, reduce write-offs resulting from untimely filing, and identify the patient’s portion in order to begin the billing cycle.

As an extension of your Business Office or SSC, HIRS staff members utilize remote access tools and technology powered by CITRIX from our U.S. based HIRS call centers to provide Extended Business Office services and insurance claims adjudication on both an hourly and contingency basis.

We provide the staff, training, physical site, IT infrastructure, and the results on a short-term or long-term basis and enable you to initiate small and large scale cleanup projects without hidden costs…at a price that you will find hard to believe.

HIRS operates on an as-needed basis. You can use our services for a week or a year, when the need is gone, we will move on.

HIRS customers can expect:

  • Access to experienced and trained U.S. healthcare receivable specialists.
  • Remote insurance follow-up staffing from our call centers in Kentucky and Tennessee directly on your patient accounting system to ensure secure, efficient, and consistent work effort.
  • Redeployment of existing staff and personnel to high-balance or high-priority projects.
  • Short term, long-term, permanent, or temporary business office staffing during computer system transitions or transition to a shared service center business model.
  • Expanded quality assurance controls including voice logging of all HIRS communication with payers and patients.
  • Integrated patient billing services to help ensure collection of patient deductible and co-insurance amounts.
  • Hold times under 25 seconds.

Reasons to partner for supplemental insurance follow-up

Surveys indicate that approximately 15-18% of insurance claims will require follow-up to ensure appropriate adjudication and payment to the provider.

Common reasons for unpaid claims include:

  • Patient and insurance demographic errors.
  • Coding and coverage issues.
  • Payer processing mistakes.
  • Murphy’s Law and Intentional Delays by Carriers.

Without a sufficient staff and proper tools, you could be:

  • Experiencing an increase in unpaid, unchallenged, and untimely claims.
  • Delaying the billing of your patient’s co-insurance and deductible amounts.
  • Creating insurmountable backlogs that lead to management’s frustration and poor staff morale.
  • Piling on days to your A/R cycle.
  • Aggravating insured patients through delayed billing of their portion of charges.

 

Our mission is to provide hospitals and healthcare partners with highly productive low cost insurance follow-up personnel without the need for the hospital’s capital investment and traditional overhead expense, so you can be more proficient and maximize returns.

Fully integrate with other CBS Services

HIRS insurance follow up efforts can also work simultaneously with other CBS programs including patient billing services performed by our Account Billing Services division. HIRS and ABS programs together can ensure that patient responsibility amounts identified through the insurance follow-up efforts are immediately billed and collected.

A flexible model to work with your team

HIRS offers a flexible model that includes the ability to work directly off the hospital systems, following the same protocol as your internal team and ensuring that all information is updated real time into your system. We also offer an hourly-rate fee structure which makes it very easy for the hospital to project, monitor, and confirm the costs and value of our services. The ability to flex our resources makes it very easy for the hospital to increase or decrease supplemental staff as volumes and business conditions require.

Other benefits to partnering with HIRS

  • We’re priced competitively. After hiring, payroll taxes, training, health insurance, and overhead, you might be paying more for your employees right now.
  • There is no unemployment when you no longer need us.
  • We don’t take paid vacations.
  • We don’t come to you with our personal problems.
  • Your volume of claims will only increase with the Affordable Care Act.
  • You may not be able to hire another FTE, but you could get approval to outsource a position.
  • Our flexible model allows resources to be increased or decreased as required by your needs.
  • We can keep your older claims from going past timely filing and let you focus on large balances.
  • Quantifiable financial benefits include cash acceleration, decrease in write-offs, and reduction in days in accounts receivable.

Ability to integrate with any software

We are experienced with all major patient accounting systems including Meditech, Siemens’ Invision, McKesson’s STAR & Paragon in addition to support systems like Ontario’s Artiva , Medicare FISS and major payer self-service portals such as Availity. We can also easily train on your system and get up to speed within 30 days.

We are an extension of your business office

We understand that your training/reference materials are part of what helps your staff maintain a uniform standard of work and ensures a high level of productivity. We would request that you treat us just like a member of your staff and provide us with the same reference materials that you would give to a new hire (albeit one with quite a bit of experience). These include, but by no means are limited to: List of Facilities, addresses & Accompanying NPIs, PTANs, PINs, List of Payer Codes, Claim Forms, Quick Phone Reference Guide, Policies on Self Pay billing, etc.

Single point of contact

HIRS provides you with a single point of contact to work through. If there’s a problem, we want to identify it and correct it right away, but we also like hearing good news & compliments. Our contact will keep in touch with your project coordinator on a daily or weekly basis to find out how things are going and discuss any trending issues.

Extensive and customizable reporting

While our clients would certainly be able to generate reports from their own system with more detail, we will still provide you with daily/weekly/monthly reports listing number of units worked, account numbers of the units worked, dollar amount of accounts resolved, number of hours worked, monthly & weekly cost estimates. Any special reporting functions would need to be coordinated through our IT department.