Top 10 Rev/Collect - ML-Driven Denials Workflow Optimization Alternatives & Competitors

Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.

Gone are the days of illegible, incomplete, inaccurate faxes sent back and forth between the physician’s office and the facility’s scheduling department. The cumbersome and error prone faxing process is replaced by an electronic form that is configured to each facility’s exact specifications and reacts to the user’s input thereby assisting the physician’s office in getting it right the first time.

All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.

Our single platform approach provides immediate visibility into revenue cycle opportunities, tackling some of today's biggest challenges with the following Productized Analytics Suite Modules:

• Workforce Quality Insights (WQI) – Links front-office actions to financial KPIs
• Patient Access Insights (PAI) – Enhances financial experience pre-service
• Revenue Integrity Suite (RI) – Reduces denials and compliance risks
• Productivity Analytics (PA) – Improves staff productivity in real-time
• Cost Insights (CI) – Targets controllable costs
• Business Office Suite (BOS) – Unifies patient accounting data

Clinical denials require focus and clinician intervention. With more than 100 clinicians on staff, R1 Physician Advisory Solutions can help. We support physicians and case management by navigating the regulatory environment and providing concurrent recommendations to increase billing compliance and reduce clinical denials. Services include remote utilization reviews, admission status reviews, payer peer-to-peer reviews, chart audits, appeals management, and customized education programs for physician and case managers.

No two denials are the same, and your team needs to submit appeals quickly and efficiently. Our technology automatically identifies denials that can realistically be overturned, prioritizes them based on predicted cash value, and populates payer-specific appeal forms. Denial + Appeal Management from Waystar offers:

• Disruption-free implementation
• Customized, exception-based workflows
• Robust reporting and analytics to help make process improvements
• An Appeal Wizard that integrates into your PM or EMR system
• Payer scorecards to help guide more favorable contract negotiations

Optimize your policy management.

The Most Comprehensive Database

Access the most complete database of live and historical medical and pharmaceutical policies and related documents on the market.

Real-Time Notifications

Stay ahead with email alerts on any changes to medical and pharmaceutical policies by payer and therapy, allowing you to respond swiftly to developments that may impact your stakeholders.

Central Access

Effortlessly search and review Medical & Pharmacy policies, draft policies, prior authorization documents, coding guidelines, reimbursement updates, and more—all in one centralized location.

Comparison View

Easily identify differences between current and historical versions using our intuitive viewer that highlights changes for quick reference.

Research Control

Focus your research by filtering specific payers, plan types, states, therapies, devices, or document types, ensuring you find exactly what you need.

Visit https://www.policyreporter.com/industry/providers/ for more information and a free trial.

Processing insurance claims can be a labor-intensive task, involving extensive documentation, data entry, and manual effort. CampTek has an Intelligent Automation solution will do the following things:

• The integration of AI identifies problematic payors and claim types. These types of issues can be remediated via System configurations or through automation.   
• Larger more repetitive workflows can also be automated at scale.  
• This an end-to-end solution can be implemented to solve the issues with a claim before it is submitted but also as a continuous improvement of workflows.  

Automated Data Extraction and Transmission:

It will automate the extraction and transmission of data related to the insurance claim in any EHR/EMR, payor portal and clearing house. 

Unstructured data, such as handwritten notes or scanned documents, can be automatically extracted and organized and entered into an EMR/EHR, ERP System, payor portal or clearing house website. It’s accurate and consistent.  

Average Annual KPI’s for a Provider with $3B Annual Net Patient Revenue:

• Efficiency and accuracy increased by 48% 
• Accelerates reimbursement by 38% 
• Reduces rework and denials by 30%