Denials Management

FUSE eliminates the manual reconciliation of remittances to deposits, along with the manual posting of payments into the patient accounting or practice management system.

A data science and AI-powered denials management solution that integrates with our client's existing workflow tool(s) with a two-pronged approach, both preventing denials and managing them efficiently through AI-based prioritization. There are two options available for clients, one that includes a best in breed clearinghouse and one that can be deployed with a client’s existing clearinghouse. If the client adopts the full solution including clearinghouse, unlimited edits are included and added within the system. If a client chooses to continue using their legacy clearinghouse, Sift's solution functions as follows: Smart claims edits are generated daily for all new claims based on 837 data. Recommended edits that should be in place are clearly prioritized in a dashboard, and alerts can be arranged per client specifications. Denials that are not prevented are also run through a proprietary claim scrubber post-denial to catch additional edits that were not caught “upstream” by the health system’s EHR-based claim edit engine or its clearinghouse, ensuring these denials will be prevented in the future. Denials that persist are then automatically prioritized based on AI-trained models that integrate with existing work queues in the EHR or other workflow tool. Results and team productivity are carefully tracked and provide valuable business insights to revenue cycle leadership.

Assurance Reimbursement Management is an analytics-driven claims and remittance management tool that helps healthcare financial managers efficiently manage all types of payer claims, including commercial, Medicare, Medicaid, and Worker’s Compensation, in one integrated system. Assurance provides ongoing claim visibility and supports proactive just-in-time follow-up until payment is received. Assurance Reimbursement Management gives hospitals, physician practices and other ancillary providers the capabilities to accelerate claim payment, limit denials, improve resource utilization, and reduce costs.

Acuity Revenue Cycle Analytics is an analytics platform that leverages data from across the revenue cycle continuum (from patient access to remittance) to provide a holistic, cross-functional view into behaviors, processes and trends for the purpose of making timely decisions impacting financial outcomes, staff productivity and patient experience. • Dashboard showing a snapshot of critical information to quickly and easily identify problem areas in the revenue cycle. • Data compilation is automatic and in near real-time. • 80+ standard (yet also customizable) reports are available. • Users can create unique reports using any available criteria for unique use cases. • Suggested performance thresholds based on industry-wide data give context for whether performance is exceeding, on track or lagging goals. • Offers suggested thresholds or customize to meet unique needs. Visual indicators highlight when performance is outside of thresholds. • Acuity Advisor helps guide use of the wealth of data within the application by suggesting reports for common issues. • Reporting Bundles include visibility into data to improve processes in Patient Access, Services Rendered, Billing Efficiencies, Reimbursements, Denial Analysis, and Payer Relations.