FAQ – Frequently Asked Questions
Have a question? We have answers! If you don’t see your question answered below, then please head over to our contact page and let us how we can help. We’d love to hear from you.
A few questions will tell you how effective your process is.
What is your true overturn rate? This is the percentage of recovered dollars over a specific period divided by the total denied dollars for the same period. Regardless of whether the denial was appealed or not.
Many appeals departments and even vendors report on overturn rates as a % of cases that they actually choose to appeal rather than as an aggregate percentage of total dollars denied, there is a HUGE difference.
- Is your overturn rate less than 20% of all dollars denied?
- What is the ROI of your appeals process?
- Are you getting less than 60 cents for every dollar recovered because of the cost of appealing cases?
- How strong is reporting associated with your appeal process?
- Would you like to have actionable reports that drive to the root cause of your denials and can help you develop interventions to reduce denials?
A yes to any of these questions or a desire to get more out of your appeals department should prompt you to evaluate your denials prevention strategy and explore other options for managing physician driven denials.
The short answer is YES, it absolutely can be.
The priority in any denials reduction strategy is reducing denials at the source before they occur.
Once a denial occurs, it is a sunk cost and any activity involved in overturning that denial should be looked at from a purely ROI perspective.
An outsourced solution with a contingency contract guarantees a high ROI.
The cost of doing appeals in house is often much higher than expected when you factor in all costs including clinical staff, follow up staff, managerial oversight and distraction, printing, stationary, postage. It is very difficult to get a high ROI.
The most important question in considering an outsource solution is selecting the right partner to work with.
CMC can show you Alternative proactive solutions that will increase revenue and decrease costs while maintaining the high standards of care your facility is known for. But we encourage you to run the numbers yourself.
Yes we do. We work with both inpatient and outpatient RAC appeals.
Additionally we can provide reporting that will let you know your greatest areas of Medicare vulnerability before CMS Audits even occur.
Every facility is unique, and with the ever changing landscape of healthcare the one size fits all strategy doesn’t work. In most cases CMC can provide ZERO up front cost, contingency based solutions that will help you meet your goals of eliminating denials, and give you a guaranteed return on investment.
CMC has over 80 standard reports, and can tailor reports to meet your specific needs.
Our reports focus on three main areas.
- Status reports that provide you with the status of every denial you assign to us.
- Reports on outcome, that provide you with detailed updates on dollars recovered and rates of recovery.
- Most important is interventional reporting that provides you with granular detail on the drivers of denials by diagnosis, physician, insurer and denial type.
Our reports get down to the Granular level, giving you the detailed information necessary to eliminate holes in your revenue bucket. Additionally we provide not only the data but specific recommendations so that actions can be taken in the most impactful and cost effective manner to increase revenue and reduce denials, without impacting quality of care.
Ongoing reporting allows you to evaluate the effectiveness of these steps, and continue to identify additional areas of improvement.
This PROACTIVE approach has proven to reduce Denials as a whole by 25-50% or more over time, helping our clients get closer and closer to the goal of eliminating denials all together.
We actually hear this a lot. Mainly from Facilities that have in the past or are currently outsourcing some of their appeals process. We respect and understand why you feel this way. Prior to working with us, most of our clients felt the same.
However time has proven that our clients have found a different experience when working with us.
CMC has made seamless integration into our clients operation a top priority for our company. We take on the technology burdens of set up in working within your system, and other then granting access, we handle everything else. We truly become a trusted source of revenue recovery and information for our clients, with the feel of an extension of their own organization.
With the CMC advantage, it can truly be as simple as telling us the cases you want us to work on, and then waiting for the money to roll in, in a timely manner. With regular reports and updates every step of the way.
Every facility is Different, and while it is nearly impossible to completely eliminate denials all together, working towards that target should be the goal of every Finance and Medical Management department.
A good bench mark should be denials as a percentage of operating revenue. With the goal of reducing denials down to less than 1% of operating revenue.
If your facility has denials greater than 1% of operating revenue, then there is room and possibly significant opportunities for improvement. Contact us for a free consultation.
If your denials are less than 1% of operating revenue it may be time to evaluate the ROI on your current appeals process. (If I am recovering $1 million dollars, but spending $500,000 or more in salaries benefits, support personnel, oversight, and supplies just to submit the appeals is it really worth it? )
CMC can get started in as little as three to four weeks.
None. CMC takes on the entire infrastructure and processing burden, and once secure system access is established, we do all the work. You simple email us the account numbers you want us to work on, and we do the rest while you sit back and await timely payment. We provide regular reporting as to the status of each appeal. Our goal is seamless integration into your current system with no administrative burden.
ALL MEDICAL NECESSITY DENIALS (MND)
ALL CMS DENIALS INCLUDING RAC, MAC, POST PAY AUDITS, 2 MIDNIGHT RULE ETC.
ALL HMO AND MEDICAID HMO MND
ALL COMERCIAL MND
ALL VETRAN ADMINISTRATION MND
CMC is HIPAA compliant and we maintain the highest levels of data security for our clients and training for our personnel.