Applied Management Systems (AMS) utilizes a multi-phase approach to assist hospitals with Denials Management.
As many over-payments are attributed to medical necessity, documentation and coding, AMS begins with Denials Management preparation: assessment of documentation and code assignment, followed by an evaluation of medical necessity from the medical record. This phase identifies the risks and weaknesses in the system, and prepares the hospital for the Denials Management process. A root cause analysis is also performed to complete the phase, detect and address any large-scale documentation and/or coding issues.
- Management –
The volume of third party Audits has increased dramatically over the past decade becoming difficult in volume for providers to manage. The sheer volume of adverse determinations places providers in a very difficult position, often missing important deadlines when unable to provide no response within a given time frame. This makes the tracking of denial deadlines and correspondence a critical piece of the process. AMS will oversee the management and course of denials, and ensure that the hospital meets all timeframes in order to respond and appeal to overpayment claims. AMS also offers appeal writing services.
- Appeal –
AMS consultants are highly skilled in coding and Denials Management. We will review and analyze your denials to identify appeal opportunities for DRG, medical necessity and automated claims. We use a denial tracking and management database to manage appeal deadlines, response dates, medical and administrative evidence, appeal rationale and alerts.
Benefits of Appeal:
- More appeals means less exposure
- Achieve optimal financial performance