Adreima brings a unique clinical perspective and tactical results to the front, middle and back-end of the revenue cycle that secure coverage for patients, increase revenue opportunities for the provider, minimize denials and reduce days in AR. Our teams of clinical, financial and eligibility experts navigate complex reimbursement matters to assure appropriate reimbursement and mitigate risk for hospitals and the communities they serve.

Access Matters

We work hard on behalf of hospitals and their patients to ensure the integrity of insurance coverage, identifying appropriate government and managed care programs, and doing what is necessary to get patients enrolled. Our success in this area is a result of experience, cutting-edge technology and hard work.

Eligibility Services
Adreima offers tailored solutions to identify and secure programs available for patients that can yield higher reimbursement for hospitals for inpatient, outpatient and ED services. Armed with our robust technology, rich database, and proven processes for discovery, our on-site Eligibility Specialists and our Disability Experts serve as advocates for patients to uncover eligibility for a variety of government and other financial assistance programs including SSI, Victim of Crime, or liability-related injuries, to name a few. We offer friendly and thorough assistance for completing the application process, and we manage the patient’s case through resolution.

Medical Prior Authorization
When planning for Medicaid in-patient services, the process of obtaining prior authorization from the state or the state’s contracted provider is complex and time consuming. Adreima can save hospital case managers a lot of valuable time. Our centralized team of skilled clinicians, registered nurse auditors and certified coders conducts medical necessity reviews concurrently to coordinate authorizations. In addition, the team conducts retrospective reviews to appeal denied days or secure authorizations on newly covered Medicaid recipients.

Revenue Matters

Hospitals exist to serve the people of their communities in extraordinary ways. It’s the passion of everyone who works there. But to accomplish anything takes revenue—the lifeblood of any business. Every drop is precious.

Charge Description Master Reviews
Adreima’s CDM reviews include accuracy of codes and regulatory compliance, protocol and interface assessment and staff education. And, we work closely with you to strengthen process controls throughout your hospital. Accurate and comprehensive charge identification and capture is vital to revenue, and it’s a process requiring true experts.

Charge Capture Review
Accurate and comprehensive charge capture is vital to revenue integrity. Recognizing those discrepancies involves clinical and financial processes that are best handled by experts who know where to look and who work together to strengthen all aspects of a hospital’s charges and charge processes.

Payment Matters

Within the increasingly complex reimbursement environment, our team works with hospitals to ensure that they receive the precise payment they are entitled to from payers. Our clinical, financial and process experts all work together toward that goal. That’s our mission and our promise.

Clinically-Integrated Receivables Management Services
Adreima offers a full-suite of clinically-integrated Accounts Receivable Management services custom-designed to expedite revenue for our clients. The technology-enabled, complex processes we employ are fueled by our team of Government, Commercial and Managed Care experts. Every patient… every claim deserves our best efforts. We leave no stone unturned in the fight for payment. But collecting charges is only half the battle. Our workflow is embedded with clinical expertise that identifies denials and provides process improvement strategies to decrease denials while increasing cash. Adreima’s robust reporting provides payer specific data empowering clients to hold all government and third party carriers accountable for their payments. Knowing the gaps that are costing you money provides the evidence to renegotiate contracts that are putting your revenue at risk.

Adreima doesn’t just transfer the A/R burden from your team to ours…we inject the A/R process with a clinical expertise that is second to none. Our expert clinical perspective is interwoven in all aspects of our Receivables Management services. This perspective on the front-end and at billing results in fewer denied claims and faster access to cash for our clients.

Our vast experience, fueled with our proprietary workflow technology, allows us to focus on producing a claim that gets paid correctly the first time. As a result, our full-service clients have experienced an average decrease dollars and accounts in A/R >90 days by to 10% or less within the first year.

Our Medicaid expertise allows us to quickly delineate Managed Care/Medicaid claims issues for swift remediation.

We capture payer behavior information, both specific to a client and as an overall aggregate experience with all our customers. Bottom line…we know what payers do with regard to denials and are pre-emptive in our approach. Our global payer trending experience allows us to identify payer specific revenue opportunities for individual clients.

We know that results matter. Our unique clinical perspective, coupled with our extraordinary Medicaid expertise, resulted in an ROI of 192% for a single client within the first 8 months of service. In addition, we have reduced that client’s days in A/R>180 by 68% to its current record low.

Clinical Denials & Appeals Management
Adreima offers a full complement of technical, legal and clinical expertise to handle any denied claim, both concurrently and retrospectively. Our team is unsurpassed in its ability to provide thorough and accurate analysis of clinical and financial aspects of patient accounts from presentation to resolution. Our Clinical Review Team consists of nurses, physicians, and medical coders, many of whom are specialists in areas such as NICU/Peds, Trauma, Cardiology, and Orthopedics. The team’s rigorous approach to every claim includes an in-depth investigation from the unique perspective of our significant clinical, technical and financial expertise. The result? Well-vetted reasoning and a clear communication of findings that withstand the toughest scrutiny. Whether working to prevent denials, or fighting for payment of a clinical denial, we ensure no stone goes unturned.

Adreima’s proven and vast clinical expertise that yields Breakthrough Results for clients. Unlike vendors who report success as a percentage of appeals presented to payers, Adreima pays close attention to the success rate based on the total claims provided to Adreima by our customers. This aligns incentives, discourages cherry-picking of accounts, and transfers the focus to all accounts rather than a select few. Adreima’s results include a recovery rate of 61.8% on all referred cases for all payers (which equated to an 81.4% recovery rate on all appealed cases for all payers.)

Our robust data mining uncovers sources of denials. In-depth root cause analysis includes reporting and trending by department, type of service and payers which leads to process improvements that change behavior. Our comprehensive analytics have result in a 20% decrease in denials for clients within the first year of service.

Our clinical-financial denials team consists of more than 250 specialized nurses, physicians and coders, integrated with our seasoned technical and financial team. Our clients experience optimal results because we are able to align the claim with clinician’s area of expertise. Speaking the language assures nothing gets missed.

Adreima’s Executive Dashboards enable clients to make informed decisions that affect their reimbursement.

Our payer-specific reports provide the data necessary to empower managed care contracting decisions.

Clinical Audit Support
We put into action our vast resources and technology-enabled workflow to enhance the resources of our clients with a variety of clinical reviews and audits. Our Clinical Review Teams including nurse auditors, technical specialists and coders leverage our proprietary system to capture lost revenue, identify and facilitate resolution of systemic issues, minimize recurring errors and streamline internal processes. Our focus is on increasing reimbursements and reducing recoupment costs. Some commonly conducted clinical, coding and line item charge review audits include:

Our intricately-organized teams of clinical and financial professionals provide clinical and technical reasoning and documentation for expert defense of audit findings.

Because of our in-depth documentation, exceptional foundation for defense, and clear presentation of facts, our appeals not only win, they send the message that our clients are fully prepared and discourage continued external audit requests.

Allowing audit experts to manage this time consuming function allows your clients to reallocate resources to concentrate on delivery of care, not defending care.

The Adreima clinical audit team conducts pre-emptive audits and gap analysis to mitigate risk of outside audit and uncover opportunities for process improvement.

Our compliance team is unsurpassed in identifying and modifying areas that put clients at risk for compliance-related issues.

Adreima’s robust reporting of audit issues, status, and results are augmented with recommendations for proactive corrective action. In addition, we provide payers-specific trends that allow clients to manage their business more affectively.

Post Payment Recovery
The complex reimbursement methodologies of Managed Care and Medicaid make it very difficult for information management systems and patient accounting team members to determine if payments are correct. All too frequently, payments are accepted that are well below the correct amount. Our specialized team of experts review paid claims to determine if additional recovery is possible. We then rebill, follow up, and appeal on those claims until appropriate payment is received. In addition to recovering additional revenue, our Patient Account Specialists and Clinical Audit Teams utilize the evaluation of specific claim details to identify trends and issues causing underpayments so that these systematic problems can be resolved and future claims paid correctly.

Adreima’s post-payment recovery audit finds and recovers what clients miss. Often overlooked components that can lead to underpayments include:

An effective post-payment recovery program keeps payers accountable and identifies trends that affect reimbursements on a go-forward basis.

Adreima’s intricately-organized teams of clinical and financial professionals prepare billing documents for deserved additional revenue and aggressively follow-up with payers to ensure accurate revenue is recovered.