Manage Denials, Underpayments, Pre-payments and Retrospective Claim Audits
Although audits and claims denials have always been facts of hospital life, new auditing agencies and ever-changing payor rules make it more difficult to respond adequately. Adding staff is not a likely scenario so leading hospitals are turning to automated tools to manage the situation.
Craneware’s Revenue Recovery & Retention solutions give you the ability to recover and preserve more reimbursement, using your current staff levels.
Craneware’s Audit & Revenue Recovery product family:
- Manages claims denials from all payors, and uncovers the root causes of denials. The automated workflow distributes denied claims to appropriate staff.
- Manages details and deadlines for Recovery Audit Contractor (RAC) and other external audits, from a central location. And weighs likely outcomes and calculates dollars that you should put in reserve.
- Determines likely outcomes and calculates dollars that you can put in reserve.
- Identifies underpayments by comparing 835 remittance data with payor contracts.
Implementation of the product includes uploading your managed care contracts into the system.
Craneware’s Revenuey & Revenue Recovery products, which include, InSight Denials® and InSight Audit®n are easy-to-master ASP solutions that manage payor denials and audits..