Denial Avoidance Solution

Avoid Claim Denials

According to HFMA1, 65% of denials are never appealed. The good news is that providers can intervene on the front end to avoid denied claims and prevent this revenue leakage from occurring in the first place. ZirMed’s Denial Avoidance solution combines people, process, and technology to drive denial prevention and identify the root causes of denials throughout the revenue cycle. By leveraging denial prediction technology, advanced analytics, and proprietary advisory services, ZirMed’s Denial Avoidance software unlocks patterns and problematic attributes within your denial population.

Automate the Prevention of Revenue Leakage

Integrate thousands of data attributes from disparate sources to identify claims with a high probability of denial. ZirMed’s team of PhD-credentialed data scientists creates machine-learning algorithms that predict denials with 5x accuracy versus random spot checking. ZirMed’s advisory services team aggregates predictions over time to identify and execute prevention measures.

Improve Revenue Cycle Outcomes

Avoid denied claims and turn insight into action with ZirMed’s advisory services. The advisory team assesses your existing process, structure, reporting, and metrics to identify the root causes of denials and proposes best practice recommendations to improve outcomes. ZirMed also creates a denials management task force to target high-impact denials by type and spearhead implementation of education and process improvements to prevent denials that adversely impact cash flow.

Enhance Performance Management

ZirMed helps you foster a culture for collaboration and develop strategies for continuous process improvement across the revenue cycle. Use ZirMed’s Denial Avoidance solution to automatically triage at-risk accounts to the right staff member at the right time, and alert your management team when key performance indicators fall outside target ranges. Utilize payer-specific scorecards, analytics, and reporting at the account, claim and line-item levels to drive root cause analysis and avoid claim denials.

Integration Capabilities

By design, ZirMed’s revenue cycle management platform enables creators of healthcare technology solutions to seamlessly and easily incorporate our HIPAA and PCI-compliant applications and transactions into your software solutions. Using ZirMed’s integration capabilities, organizations seeking a traditional approach of exchanging EDI transactions may transmit and receive a variety of claims, payments, eligibility inquiries, and other healthcare transactions using established technologies and methods such as X12 files, APIs, Flat Files, FTP, Encryption (i.e. PGP), and more. You’ll have confidence knowing that your exchanges are occurring securely, in compliance with all regulatory guidelines, and utilizing existing technological capabilities.

 

1Wyatt, C. (2015, July 7). Optimizing the Revenue Cycle Requires a Financially Integrated Network, HFMA

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