Revenue IntelligenceTM

Cloud-based Revenue Integrity Solution to Improve Net Revenue

At Hoap Health, we believe that a provider should recover full economic value of a claim the first time and every time. Claims should be accurate and submitted in a timely manner thus eliminating rework. Hoap Health’s Revenue Integrity solution’s primary goal is to minimize revenue leakages and improve net revenue across the patient continuum.

On an average, our clients realize 3% to 4% in net revenue gain per year. While expensive software tools and outsourced companies focus on the high dollar accounts, we focus on the last few cents and literally deliver “found” money that always delights the C-Suite.

Key Features & Benefits:

  • Concurrent Charge Audit of High Value & Price Sensitive Accounts
  • Source System agnostic; Seamlessly works with inhouse Hospital Financial Systems
  • Intelligent algorithms to detect potential net revenue improvement accounts
  • Improve staff productivity with intelligent work queues
  • Improves Clinical Documentation & Clinical Coding Compliance
  • JCAHO Compliant Process Improvement Initiatives
  • Pre-built dashboards & reports with adhoc reporting

Revenue Integrity Suite:

Hoap Health Revenue Integrity Suite contains several modules with a singular focus on net revenue improvement. All modules are deployed via cloud for a quick time to value. Each of the modules could be deployed individually or as a bundle.

Concurrent Charge Audit TM (CCA):

  • Concurrent Charge Audit module supports concurrent, defense, and special audit charge capture audits
  • Special queries are setup to generate automated work queues
  • AI driven algorithms identify “Under Charges”, “ Over Charges” and “Missing Charges”.
  • Generate user alerts to take correction action before the bill is finalized and submitted.
  • Likely charges that are omitted from the claims are also highlighted based on the prior procedure and claim history.
  • All itemized audit results are posted to the patient account and kept in the data repository for tracking and further analyses

Managed Care/Under Payments Audit TM (MCA):

  • Retroactive payment variance module to audit managed care, commercial and denials
  • Load Payor contracts. Compare actual vs allowed payments to identify “Under Payments”, “Over Payments”, and “Missing Payments”
  • Special queries are setup to generate automated work queues
  • All potential Underpayments are kept in their own A/R system. Cash collections are tracked and posted daily, measuring the appeal success rate.

RACovery ToolkitTM:

  • Provider’s RAC Audit Work Flow Management to defend against RAC audits
  • Supports in/out patient, rehab, skilled-nursing facility and all government audits
  • Tracks end to end life cycle of a RAC Audit: RAC Demand Letter to Resolution
  • Interfaces with PFS and Denial Management Systems
  • Maintains full RAC Audit History
  • Robust library of pre-built dashboards, and reports

DigiRemitTM:

  • Converts paper EOBs to ANSI 835 for posting to billing system
  • Smart configuration engine parses all the fields on a paper (pdf or image) remit, maps to appropriate fields for cash posting file
  • Secure transmitting of Cash posting file to provider EMRs
  • Pre-Built Reports & Rich Actionable Analytics
  • Converts paper remits to digital electronic remits
  • Smart engine parses all the fields on a paper (pdf or image) remit, maps to appropriate fields for cash posting file
  • Cash posting on provider EMRs at account level

AccuRemitTM:

  • Calculates accurate expected account level reimbursement per contract
  • Contract Management Module to maintain all contracts
  • Smart engine to parse the 837 ANSI claim file
  • Secure transmitting of expected reimbursement file to provider EMRs
  • Pre-Built Reports & Rich Actionable Analytics

Bottom Line:

Hoap Health’s Revenue Integrity platform is one of the most comprehensive and cost-effective audit and analytics solutions available in the market today. Whether you have an internal or vendor-based Revenue Integrity Department or outsource audit services, Hoap Health’s Revenue Integrity solution fits all. Net Revenue gain is in our DNA. Click here and find out how !!