Value Added Services
Payer Management
Healthcare providers typically take a very reactive approach to managing payer issues by outsourcing or allocating staff to focus on:
Underpayments – Manual review or technology to identify and rebill claims.
Denials Management – Review and appeal denied claims.
Payer Negotiations – Meet with payers to retrospectively review their policies and procedures and discuss payment issues on claims.
All of these are important aspects to effectively managing your revenue cycle; however, these are all typically reactive responses. Our emphasis is on a more proactive approach that focuses on Payer Management. We recommend a four-pillar approach to drive payer accountability that focuses on the following areas:
Technology
Ingests claims, remits, contracts, and payer behavior at scale.
Data Analysis
Analyzes Payer & Product Line. Finds patterns hospitals cannot see claim by claim.
Strategy
Converts patterns into leverage, breach positions, settlement logic, and contract asks.
Tactics
Executes the pressure campaign: escalation, payer meetings, breach notices, settlement framing, and negotiation support.
Our solution is designed to replace or augment your current vendor or staff focusing on these areas. This allows all parties to align toward a common goal: build a solid payer management process that ensures you are paid appropriately for all your claims.
No Surprises Act
Net Revenue takes the following approach to managing the NSA process on behalf of our clients.
Many hospitals do not manage this process effectively. As a result, payers pay out-of-network and the hospital misses out on higher in-network rates.
Net Revenue consults with clients on documentation and billing requirements to bring processes into compliance. Our solution audits out-of-network claims to determine incorrect adjudication. We then file appropriate state and federal disputes to ensure full reimbursement.
Vendor Management
Net Revenue takes a different approach to vendor management. We offer a lower-cost solution with a customized client dashboard, and we recommend vendors that meet your unique needs.
Vendor Report Card: We look at vendor agreements to ensure hospitals are paying a fair rate and that the terms are favorable. This includes analyzing compliance, at-fault instances, and insurance levels. We then review historical performance reports to ensure vendors are performing at an acceptable level.
Consulting: In short, we manage vendor relationships on your behalf, allowing your staff to focus on their responsibilities. The consulting component includes monitoring the vendor management system, holding monthly performance reviews, and managing vendor performance.
Reporting System: Lastly, we provide the hospital and staff with a custom vendor management tool that monitors vendor performance against goals you set, thus allowing hospitals to hold vendors accountable using mutually agreed-upon performance metrics. This ensures an objective perspective of the vendor’s performance.