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The focus we have is complete satisfaction of our clients. Through a flexible menu, we have been able to reach that goal.


Denial Management Solution


Our Denial Management tools improve cash flow and reduces write-offs by analyzing denials, streamlining denial appeals, tracking the disposition of denial appeals and providing denial prevention reporting and analysis.


We can assist in:


  1. •  Analyzing Denials. Collecting and interpreting denial patterns to quantify denial causes and their financial impact.

  2. •  Appealing Denials. Generating appeal letters based on state of Ohio statutes and case citations favoring the medical provider's appeal.

  3. •  Tracking Denials. Collecting information on denial appeals, including status, escalation, correspondence with payors, and the disposition of denial appeals to increase recovery amounts.

  4. •  Preventing Denials. Providing a review of the current process and making suggestions to streamline the operations as well as other information to prevent future denials.

  5. •  Provide a careful adjudication process to ascertain correct payer is identified

  6. •  Expedite and appeal pre-certification determinations with utilization review laws.

  7. •  Partnering with existing hospital follow-up staff including the development of mutual metrics (balanced scorecard)

  8. •  Total Outsourcing of Payer with a graduated percentage of recovery dependent on age of claim

  9. •  Completion of difficult or unfamiliar processes requiring a C19 or HCFA such as: Air Ambulance, Skilled Nursing Facilities, Black Lung

  10. •  Management of Denial Database Activity specific to Workers’ Compensation Payor

Consulting Services (to hospitals/providers)


Our consulting services will include:


  1. •  WC Claim Payment Analysis for hospital providers

  2. •  Office Process evaluation and research of revenue cycle for Physician Practices

  3. •  MCO/TPA/Employer Master updates

  4. •  Transitional Work/Return to Work Programs

  5. •  FROI Completion for Emergency Departments

  6. •  Medical Dispute Resolution Process

  7. •  Occupational Health Programs

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The solution lies in the reworking of the denials (which fall into a two year statue of limitation) by the staff of CompMed Analysis. This results in captured revenue that may be adjusted off the hospital books. Workers’ Compensation accounts usually represent approximately 3-10% of the total revenue for any hospital. In analyzing the denial process and the type of denials, CompMed Analysis will also be able to construct a new operational process (through a consultative arrangement), which will ultimately create a clean claim process and thereby reduce the number of denials. We will offer a unique solution service and expertise that hospitals and providers can call on as needed by focusing on a niche section of the payer market.


If a workers' compensation claim is in the process of litigation through the Industrial Commission, we can monitor for changes to the workers' compensation claim OR re-bill to the secondary payor if the claim is denied.  This additional step increases revenue as well as patient

satisfaction.

“We chose CompMed Analysis to resolve our open workers’ compensation accounts based on their expertise and track record of success...”


Barry Franklin

Chief Financial Officer

Parma Community General Hospital