Revenue leakage is a problem that still plagues hospitals. BESLER offers a suite of services that ensures hospitals collect reimbursement they have rightfully earned while maintaining compliance.
|Inpatient DRG Validation||Transfer DRG Revenue Recovery|
|Outpatient Auditing & Compliance||IME Revenue Recovery|
|Physician Auditing & Compliance||Charge Capture Review|
Inpatient DRG Validation
BESLER has demonstrated improvements in coding accuracy ranging from 25-60% translating to tens of thousands of dollars hospitals have recovered.
BESLER’s Inpatient DRG Validation service utilizes the power of our proprietary Revenue Integrity technology platform to rapidly determine ICD-10 CM/PCS and CPT coding accuracy and appropriateness of code selection.
Our platform employs over 1,000 rules to evaluate accuracy. Unlike manual chart audits, our software looks at every single claim to identify potential issues.
Our coding analysts then examine suspect claims to identify coding error trends, overpayment risk, underpayment cost, and to correct coding issues. Additionally, they evaluate the quality of physician clinical documentation for completeness, accuracy, and compliance.
Suggested claim adjustments are then proposed to the hospital and feedback is given on trends and common coding issues encountered.
Outpatient Auditing & Compliance
With the increasing shift of services to the outpatient setting, the need for outpatient auditing and compliance is becoming more and more critical.
Outpatient audits focus on surgery, infusion and chemotherapy, emergency department, observation and other ancillary services such as PT, OT, and behavioral health.
- Evaluating your team’s skills in ICD-10-CM , CPT®, and HCPCS coding
- Analyzing your claims information to target specific areas for focused audits
- Assessing the appropriateness of ICD-10-CM diagnosis , CPT and HCPCS procedure code selection, facility evaluation and management (E&M), modifiers, and completeness of documentation to support accurate code assignment
- Validating physician orders, LCDs, and NCDs for medical necessity of services
- Ensuring correct code transfer to the claim forms and proper APC payment received on the remittance advice
Physician Auditing & Compliance
Identify incidents and patterns of potential billing and coding risk as well as opportunities where under-coding may be occurring.
The innovative approach leverages proprietary technology and the expertise of expert consultants to help you apply the right tools for your unique situation.
- Analyze your claims/coding information to target specific areas for focused audits
- Gain in-depth knowledge of your auditing/coding team’s skill level
- Understand which practitioners are at risk
- Understand which procedure and modifiers are influencing risk
- Improve practitioners’ and coders’ knowledge of E&M guidelines and code selection, NCCI Edits, and the appropriate use of modifiers
Transfer DRG Revenue Recovery
We have recovered $2.5 billion dollars of Transfer DRG underpayments for providers.
BESLER’s Transfer DRG revenue recovery service identifies claims underpaid due to improper application of the Medicare Post-Acute Transfer reimbursement rules, documents the factors that impact the claim, provides audit backup justifying the increased reimbursement and includes claim adjustment and payment monitoring. Providers can experience recoveries in as little as thirty days after onboarding.
- Our proprietary software reviews 100% of claims impacted by the Transfer Rule.
- All impacted claims are examined by an RN prior to being approved as an underpayment opportunity.
- Our compliant process minimizes the risk of overpaid claims due to multiple validation steps and proper follow-up timing.
Without displacing or disrupting a current review vendor or internal process, BESLER can provide a secondary validation of impacted claims to ensure you are identifying all potential underpayments and overpayments.
Medicare Advantage Review
BESLER can provide validation of impacted Medicare Advantage claims for plans that reimburse via DRG to ensure all potential underpayments are identified.
IME Revenue Recovery
Our deliverables provide a roadmap to process improvement eliminating revenue leakage moving forward.
BESLERs IME revenue recovery service identifies missed shadow billing opportunities and the operational/root causes of the missed bills leading to increased reimbursement opportunities for hospitals.
Our proprietary technology identifies shadow bills that were not submitted – even those for Medicare Advantage patients that weren’t properly flagged at the time of registration.
- We provide beneficiary eligibility and claim information necessary for rebilling.
- Our detailed management reports track the identified claims and confirm that timely rebilling has occurred.
Charge Capture Review
Track a charge all the way from the medical record to the detailed bill to the final submitted claim to the remittance advice.
Your claims data will be processed through hundreds of lost revenue and charge rules to flag potential issues and opportunities. We can review all of the departments in your organization or only those of specific concern.
This in-depth review identifies opportunities for charge capture, and we also provide education for your clinical departments on the charge process to ensure understanding and compliance.
We can also include interviews with key team members to identify if all hospital services—including technical fees (facility charge), and professional fees (provider charge)—are accounted for.