Claimtrust Consulting evaluates key revenue cycle control points and identifies risks to compliance and revenue. We offer consultative recommendations, development of corrective action plans, project management, and interim management of departmental or organizational departments and functions.

Claimtrust strives to differentiate itself from other vendors by providing value added consultative services to support and enhance its product offerings, as revenue cycle problems are best solved when accompanied by expert input into how to solve the issue and prevent recurrence.  Preventing recurrence is the true measure of success.

All services are provided with an unsurpassed breadth and depth of knowledge of the governmental and local payor requirements that impact reimbursement. We offer a comprehensive range of Revenue Cycle services that can be tailored to meet your individual challenges:

• Denials Management
• Chargemaster Management
• Pharmacy Chargemaster Management
• Bad Debt Analysis
• Underpayment Management
• Charge Capture
• Medical Records Coding Audit
• Billing Data Integrity
• Payment Reconciliation
• Billing Controls and Monitors
• Medicare Suspended Claim Management
• Information Systems Planning, Selection, Contracting, Implementation, Benefits Realization and Audit
• Contract Analysis
• Casemix Analysis

Denials Management
Analysis includes an assessment of current write-off practices, denial tracking procedures, root cause analysis, the corrective action feedback loop, monitoring mechanisms and appeal processing. Our team conducts a thorough review of denial reports, appeal documentation, and current remittance advices as well as interviews with the revenue cycle teams. To correct issues at their source, Claimtrust Consulting assists your hospital in creating denials databases and developing the appropriate infrastructure to perform root-cause analyses. We help your staff develop strategies to appeal denials and recover reimbursement on denied claims.

Contract Management System Assessment
Claimtrust Consulting performs a full review of contract management polices and procedures, including claim and payment interface reconciliation, variance analysis, recovery and follow-up. An analysis identifies variances against our database of local payor underpayment issues. We complete a full analysis of staffing skills and levels as well as underpayment recovery results, helping your staff develop and implement best practice policies and procedures.

Charge Capture
Claimtrust Consulting analyzes all clinical areas to assure that all services and supplies are charged, coded and billed properly. This assessment includes meeting with clinical staff to review services provided, encounter forms, code assignments, charge entry procedures, patient/charge reconciliation procedures, and daily reconciliation procedures.

Medical Records Coding Audit
To identify and quantify issues, we review coded cases against billing data sent to the payors. We identify the source of deficiencies in documentation, coding or systems. We recommend corrective actions and complete recoveries based on the payor’s filing deadlines.

Billing Data Integrity
Claimtrust Consulting ensures that all charge data is accurate with respect to payor-specific CPT, HCPCS and revenue codes. We test the billing data flow to confirm that internal rejection reports are “turned on” and are reconciled daily to the A/R system. We review all master dictionaries that impact billing such as doctor master codes (e.g., NPI, UPINs, payor-specific provider numbers), disposition codes and credentialing. We also review compliance with payor-specific claim form logic.

Chargemaster (CDM) Review
Clinical areas with a high level of billing complexity such as Pharmacy, Nuclear Medicine, Radiology, Operating Rooms, Nuclear Medicine, and Cardiology Procedure Areas are reviewed by Claimtrust Consulting. We recover lost revenue, implement recommended changes, and provide policies and procedures for ongoing CDM maintenance.

Payment Reconciliation
Reconciliation is the assessment of whether or not a claim was paid correctly and fully. With or without the use of a contract management system, we review the identification, feedback and resolution of the underpayment and overpayment variances. We then develop procedures to ensure that your hospital collects all the revenue associated with underpayments in full. Revenue identified as “lost” can be recovered within the payor’s allowable time limits.

Billing Controls
An assessment will be made to test billing controls:

• Missing charges
• Late charges
• DNFB – monitoring key thresholds
• Claim submission controls (scrubber reports)

Medicare Suspended Claim Management
Claimtrust Consulting reports aggregated data on claims suspended in Medicare locations. We trend issues and help your institution take corrective actions to resolve pended claims and prevent future rejections. Claimtrust has developed a tool to address the cause of each error code and a corrective action step to resolve the pended claim.

Information Systems Planning, Selection, Contracting, Implementation, Benefits Realization and Audit
Claimtrust documents and evaluates your current revenue cycle systems environment. As issues are identified and documented, we recommend system corrections or enhancements to positively impact reimbursement.

Contract Analysis
Contract analysis consists of high level reviews of your hospital’s HMO contracts. Claimtrust Consulting identifies vague language and terms that may contribute to underpayment or non-payment for services. We make specific recommendations for carve-outs and add-on payments based upon the findings of our review.

Casemix Analysis
Claimtrust performs a casemix analysis and coding validation. We review your current method of evaluating the DRG validation process and make recommendations on coding and documentation practice that impact reimbursement.