Data Services to improve your Revenue cycle management for Epic​

The Reality​

Revenue Management Cycle is complex process for Hospitals. We provide data and business services which will help you to bring down the rejection and denial rate below 5%

Data Services

We provide latest data files and processes to generate clean claims data to be submitted to insurance companies

National Uniform Claim Committee (“NUBC”) codes

We provide Health Language NUBC UB-04 Data File license for Epic that contains an Epic-compliant format. e Provide NUBC UB-04 Data File for Epic that contains an Epic-compliant format as of the Official UB-04 Data Specifications Manual, together with any updates (“UB- 04 Manual”)

Local Coverage Determination (“LCD”) files

We provide Local Coverage Determination (“LCD”) to use in conjunction with the Epic System Corporation Electronic Health Record (“EHR”) solution.We Provide an Epic-compliant and ready format. LCD file includes frequency data and medication checks

National Correct Coding Initiative (“CCI”) datasets

We provide Local National Correct Coding Initiative (“CCI”) to use in conjunction with the Epic System Corporation Electronic Health Record (“EHR”) solution.We Provide an Epic-compliant and ready format. LCD file includes frequency data and medication checks

Revenue Code Crosswalk data file

We Provide Coding Cross Reference Table (Revenue Code Crosswalk) data file. We Provide an Epic-compliant and ready format and it is valid for all CPT and HCPCS Level II codes

All Patients Refined Diagnosis Related Groups (“APR DRG”) license and data files

We Provide All Patients Refined Diagnosis Related Groups (“APR DRG”) license and data files. We Provide an Epic-compliant and ready format.

Claims Denial Management

Machine learning rules to review the clinical editing patternn from various sources CMS(Medicare CCI, MUE, Follow-up days, Modifiers, LCD, NCD etc.), Medicaid (State’s Medicaid policies)

Recent Projects

Revenue Management Datasets for Hospital

For new Epic implementation, we provided setup of NUMBC, LCD, CCI, APR and Crosswalk data sets.

Reduced Medicare claims rejection rate

We implemented required HIPAA L1-L7 validations, code sets validations and claims relationship validations to submit clean claims

Claims Denial Management for Hospitals

Improve first pass rate with significant reduction in Claims denials. Currently Hospitals claims denial range from 15-20%. Reduce Admin cost by automation and BPO model.

Detailed Process

We start with historical claims to be run against HiPaaS Clinical editing database and machine learning rules to review the patterns.

HiPaaS Clinical editing database contains data from various sources CMS(Medicare CCI, MUE, Follow-up days, Modifiers, LCD, NCD etc.), Medicaid (State’s Medicaid Payment/ clinical editing policies) and appropriate Payers payment policies.

HiPaaS will Recommend/Provide correct coding guidelines/suggestion and flag the edits prior to sending it to Payer and it can be corrected prior to sending the Claims.

Could be enhanced to configure Rate/Fee as per provide contract to track payment alongside. Could be enhanced to link with various Groupers to test the claim correctness for APC, APG, APR-DRG, MS-DRG, LTC/SNF etc.

This is be cloud based and light weighted system with dynamic validation and regular database update.