Charge capture analytics that identify risks to revenue and compliance
In today’s evolving healthcare climate, payment models continue to change from the traditional fee-for-service model to more blended payment methods causing risks to revenue and compliance. Regulatory and payment information changes constantly, and if your systems aren’t updated in a timely manner, claims can be filled with coding errors, missed charges, and compliance issues. Charge capture issues result in increased claim denials, costly back-end processes, and loss of revenue.
Trisus Claims Informatics, a retrospective charge capture analytical application, identifies high-impact areas of risk for your team to investigate. This solution was created with the user in mind, based on customer feedback and requirements, and combined with analysis of over 200 million billed claims. By importing both claims and remit data sets from your patient accounting system, Trisus Claims Informatics uses prescriptive analytics on your own data resulting in higher accuracy of issues found. You can also see the potential gross impact of an issue, giving you quantitative data on potential revenue loss.
Trisus Claims Informatics helps you identify these risks through:
- Drill-down dashboards to quickly identify high-impact issues
- Root-cause analysis wizard which walks the user through the steps of auditing to correct the issue at the source
- Issue grid that is easily sorted, grouped, and filtered
- Potential gross impact identifying potential revenue loss
- Actual impact to display actual revenue loss after remittance
- Visibility of denials associated with claim issues
This robust tool is built on our next-generation cloud-based platform, Trisus, allowing for daily imports of your claim and remit data, as well as frequent updates from The Craneware Group to quickly adapt to industry and regulatory changes. These features, combined with the most accurate and current reference data in the industry, ensure your team’s success with post-bill audits.
During implementation, our consultants, who have a passion for revenue integrity, visit your organization on-site and perform a sample audit to identify your top five high-impact issues. Our consultant works with your team to audit, discuss corrective action plan development, and how to implement the plans. Our methodology includes training, workflow development, customized rules, and report creation, positioning your team for success.
Trisus Claims Informatics: Safety Net for Rules-Driven Exception Workflow
“Our organization partnered with a leading consulting firm and peer consortium to boost the 16 introductory Epic rules built into Revenue Guardian to nearly 1000, representing an investment to optimize this EPIC functionality. With this added value, our Revenue Integrity team can align exception occurrences with the clinical or revenue cycle operations departments for prompt correction.
As we learned, however, an encounter may be free of Revenue Guardian triggered exceptions yet may have potential errors at the claim level. Potential charging, coding, and/or claim level errors were discovered, identified in a preliminary review of their data by The Craneware Group using Trisus Claims Informatics (TCI). The findings were valuable enough to further invest in the accuracy, completeness, and compliance of their claims with TCI.
Using intellectual property that is different than what might be built into Revenue Guardian by a hospital or health system, TCI has demonstrated its value as a safety net, scrutinizing the integrity of the processes that affect charging, coding, and/or claim-level, payer-driven manipulation. The discovery of systemic issues and other opportunities for improvement has proven to be very valuable.”