Claims Management Service
- Turning difficult, stalled and backlogged healthcare accounts into cash.
- Specializing in out-of-state Medicaid billing, follow-up and provider enrollment.
The Human Arc Claims Management Servicesm turns difficult, stalled and backlogged open healthcare accounts into positive cash flow. As examples, we are experts in out-of-state Medicaid billing, follow-up and provider enrollment, as well as the management of accounts through to verification of payment in customers’ legacy systems during their PFM system conversions.
Why CMS is Relevant
A few percentage points on a balance sheet can spell the difference between economic viability and fiscal difficulties in today's health care environment. Because of this, attention to cost and income criteria is critically important to hospital management. Staffing from admissions through account management and finance is always under examination. Staff training time and dollars are scarce. Couple this with the expanding complexity of public and commercial payer procedures, plus the fast pace at which they're modified. Finally, information technology is changing rapidly too, and system conversions by hospitals often increase the time accounts sit as receivables and reduce cash flow. CMS works as an experienced and totally up-to-date extension of healthcare providers' own business office staff; we specialize in untangling the difficult cases, turning idle receivables into cash and freeing client staff professionals to work more efficiently and effectively within their core areas of expertise.
CMS also provides additional reimbursement (often "adjusted off") to providers on out-of-state Medicaid patients. We accomplish this by:
- Verifying recipient eligibility, and, when necessary, assisting the patient with eligibility enrollment and/or re-certification.
- Accurately completing the often lengthy state provider enrollment applications.
- Ensuring the provider number is obtained in a timely fashion.
- Obtaining required pre-certification or retro-certification.
- Submitting claims electronically (if possible).
- Verifying payment accuracy.
As a result, CMS provides additional dollars to clients and an increase in their disproportionate share. CMS also provides its clients with up-to-date, state-by-state provider matrices containing valuable and easy-to-reference information.
Major CMS Benefits
- Maximized revenue stream - with reimbursement secured on up to 90%, and in some cases even more, of viable unpaid and past-due accounts. That means more money in.
- Minimized accounts receivable cycle - known to be shortened by 10 or 20%, sometimes even more. That means more money in - faster.
- Optimized operational efficiencies - with the right outside staffing, easy to implement, and representing an excellent knowledge pool our clients can tap to leverage their own efficiencies.
The Human Arc Edge
Through Human Arc, CMS gives you an unmatched array of advantages:
- Experience - Human Arc has well over a decade of experience with the widest variety of claims management efforts. Our staff has the business and clinical depth to understand both sides of these issues, and we have certified coders and nurses to quickly spot and understand the most complex details.
- Breadth of Capability - CMS turns problems into solutions - and cash -- on a wide variety of client concerns, including ongoing billing and follow-up, out-of-state Medicaid, A/R cleanups, system conversions, system reconciliation, payment verifications, appeals and more.
- Minimum Risk - CMS clients do not need to invest in expensive software or other in-house capacity that only obsolesces over time. We emphasize leveraging our expanding expertise and technologies rather than risking your capital.
- Optimal Intelligence - Human Arc is famous for the depth, flexibility and functionality of its reporting to client management, exactly what you need, in the right form, right when you need it at your fingertips, so you are 100% up to date and able to make the best account management decisions.
- Security - Human Arc is 100% trained in HIPAA requirements. You can be totally assured your patients' privacy and information confidentiality are fully protected
CMS Case Studies
Nothing speaks like proof, so here is how CMS has actually helped its clients.