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Payer Resolve 360

Proven operational workflows to ensure full adjudication and reimbursement

Third party payers benefit when hospitals fail to pursue reimbursement on obscure or complex claims or on claims that are denied. Effective and knowledgeable third party billing, follow-up and collections, while leveraging all of the federal and state regulations and managed care contract language and advanced workflow technology can have a significant impact on hospital cash flow.

Payer Resolve 360 offers specific services targeting the most common to most complex payer reimbursement situations in which hospitals under collect or write off collectible accounts due to lack of time or expertise with these challenging and complex claims.

Leave the driving to EOS Healthcare

Motor vehicle accident claims are difficult to manage, due to the interaction of no-fault adjudication, private insurance, state law and other factors. EOS Healthcare has specialists who have the expertise and time to ensure that these claims are pursued effectively and on a timely basis, freeing your staff to focus on more routine claims.

Don’t let Worker’s Compensation claims injure your A/R

Workers’ compensation claims are not paid and/or denied if they are not properly billed, submitted timely or out of compliance with state regulations. EOS Healthcare has the staff and expertise to properly manage the billing and follow-up on these complex claims, capturing the appropriate contractual reimbursement and thus delivering increased net cash improvement and decreasing related underpayments and days in A/R.

Make sure your claim is paid in full

Sometimes, insurance companies underpay a claim when the full amount may actually be appropriate. Hospital staff rarely have the time or experience to contest underpaid claims. EOS Healthcare has the knowledge and the staff to know which underpayments to contest and to contest them effectively.

Respond aggressively  to clinical and administrative denials

When in doubt, a third party payer is likely to err on the side of a denial. Often hospitals don’t have the bandwidth, process, or technology to defend against payer denial strategies. Payer denial strategies result in increased days in A/R, increased write-offs, reduced cash flow and net revenue.

By turning these claims over to EOS Healthcare’s experienced staff, your staff is freed up to work other claims, knowing that EOS Healthcare will appeal these denials quickly and effectively.

A little number times a big number is always a big number

Many hospitals and physician practices end up with a large number of low balance accounts which they cannot pursue cost effectively. EOS Healthcare has the scale and automation to significantly reduce your low dollar claim backlog. While the amount per claim is relatively small, the resulting cash flow impact can be high, due to the large number of such claims.

Turn old claims into cash flow

Aged accounts are accounts which your existing in-house staff and process have been unsuccessful in resolving. With the passage of time, such accounts become harder and harder to collect. Often these accounts required specialized skills or attention and end up stuck in queues already overflowing.

By turning these claims over to EOS Healthcare, you will free up your staff to work on other accounts, increase your cash flow and reduce average days in A/R.

EOS provides extra resources to ensure a smooth conversion

Converting back office systems is always a complex process, often more complex than originally envisioned. EOS Healthcare has helped many hospitals get through conversions with minimal impact on staff productivity and A/R. Hospitals can assign A/R to EOS Healthcare, reducing the burden on staff managing a system conversion or learning new methods; or EOS Healthcare can add additional skilled staff to the hospital team.

Engaging EOS Healthcare to support your system conversion gives your staff the critical time they need to ensure the conversion is completed successfully and accomplishes its original goals without an inordinate impact on ongoing operations.

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At home in over 25 countries.
More than 8,500 employees.
Over 50 operating companies.