Engage Improves Revenue Cycle Management Efficiency

At Engage, our objective is to ensure clients receive and retain the appropriate reimbursement for the services provided to the patient. We systematically identify aberrancies in claim submissions, correct and mitigate the deficiencies, and support claims through the medical review process consistent with appropriate claim adjudication and maximized reimbursement. In addition, Engage has the knowledge and systems to identify revenue integrity weaknesses. Our team will deploy best practice solutions and proprietary processes to address gaps and optimize the revenue cycle.

Our experience guides us to the areas where revenue leakage frequently occurs. We specialize in identification of the revenue gaps others may miss as well as the development of actionable, productive solutions to correct and prevent the loss of revenue throughout the revenue cycle. In addition, our solutions are agnostic and will work with most deployed processes or systems. As such, we work to minimize any additional spend while empowering your existing processes.

Our experience has shown that most claim denials are avoidable. These avoidable errors may be the result of missing or insufficient documentation or a case of improper coding. Regardless of the cause, an error has occurred and may not be uncovered for months or years. This leads to unnecessary medical review denials and, more importantly, mounting reimbursement liabilities that could have been easily identified and mitigated through targeted medical review and auditing. Engage can help improve your revenue integrity efforts and avoid these denial situations through targeted pre-submission claim review.

Our experienced team of review and auditing specialists at Engage perform pre-submission review of claims to ensure coverage criteria is met. We take a targeted approach and select claims based on an algorithmic prioritization process. This allows the deployment of resources only where an expectation of claim inaccuracy is present thereby controlling review costs. Our process provides clients with a high rate of return on the review investment, assures the maximum allowable reimbursement, identifies any structural deficits in processes and reduces administrative cost driven by frequent denials and subsequent appeals.

The Engage Health review and audit team is comprised of highly trained and knowledgeable staff, that specialize in identifying claim irregularities. Utilizing a team of board-certified physicians, registered nurses, certified coders, reimbursement specialists and contract analysts we evaluate each claim to ensure accuracy. Special attention to the encounter, post discharge transitions and the patient’s entire health continuum is considered in our proprietary analysis in order to ensure revenue potential is maximized. When an issue is identified, the Engage team will work to address the claim at hand and improve the workflows necessary to prevent the issue from happening again.

Expertise Across the Claim Spectrum

Our experience is unique.

For more than a decade, the team at Engage has been identifying payment aberrancies and navigating the appeals or denial management process. We understand what encumbers the revenue cycle, where corrective action is needed along the processes and the most effective best practice strategies to alleviate issues on a move-forward basis. To that end, we’ve developed a specialized suite of consultative services to appropriately maximize health system revenues.

The consultative team at Engage will increase charge capture rates, identify additional underpayment opportunities, lessen documentation denials and much more. By preventing claim denials upfront, high return, cost sensitive solutions that overcome the recurring challenges faced by healthcare systems, will exponentially improve your systems operations and bottom line.