Revenue Integrity
98.6% recovery success rate
$4B+ recovered on behalf of our clients
40+ years servicing healthcare customers
2% - 5% expected increase in recovered revenues
Integrated cash flow analytics
Overview
Exela’s revenue integrity platform enables healthcare providers to monitor and optimize their reimbursement processes through integrated solutions addressing the entire revenue and reimbursement lifecycle.
Leveraging decades of experience and cutting-edge technologies, we maximize reimbursements and dollars recovered, reduce or eliminate related overhead, and enhance employee, provider, payer and patient satisfaction.
Ensure proper billing, clean claims, and optimized collection practices to reduce costly downstream work, maintain compliance, avoid denial of payment, and prevent revenue leakage.
Contract Management
The crucial first step in ensuring your Revenue/Reimbursement Cycle functions properly is Contract Management. Exela’s Revenue Integrity solution scans, loads, indexes, profiles, and maintains all contractually obligated third-party payer agreements. The platform ingests, digitizes, and analyzes data from executed contracts to not only confirm payments meet expectations, but also provide helpful alerts and notifications
Underpayment Identification and Recovery
Utilizing state-of-the-art technology and experienced professional staff, Exela’s revenue integrity program identifies retrospective, concurrent, and potential future underpayments from all contractually obligated third-party payers. This includes detailed analysis of expected and actual reimbursement remitted on a concurrent daily basis and retrospectively for the most recent 2-3 years.
Predictive Contract Modeling
Exela’s solution includes sophisticated contract modeling capabilities that provide accurate reimbursement calculations for current and future contractual agreements. Using the most recent one-year patient dataset, Exela develops multiple scenarios to arrive at the net dollar and percentage increase or decrease, helping you plan strategically.
Contractual Allowance Shadowing
Exela’s third-party payer calculation engine and adjudication system verifies the correct payer code assignment at time of final billing, ensuring the correct contractual allowance is posted. Our solution is designed to complement, supplement, or even replace existing provider processes.
Denials Management
Exela’s Denials Management solution includes tools that utilize the verbiage, reason, and remark codes contained on the respective payer’s 835’s to quickly track, address, and resolve denials and work to eliminate systemic flaws and recurrences.
Collections Services
Bay Area Credit, an Exela Technologies brand, has more than 50 years of comprehensive collections services experience and is licensed in all 50 US states. Our industry-leading recovery rates are achieved through flexible, scalable global operations. We handle first- and third-party debt at any delinquency stage and first-party soft collections, including bill reminders and notifications. Our services are results-based. We don’t get paid unless you do
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