Denial Management- ORS will go back 1 to 2 years (whichever the hospital prefers) and look for all denials and write offs that the hospital was not paid. Once ORS has completed this initial part of the process, the claims and write offs found are filed out to the companies disputing the pay; Managed Care, Commercial, Medicare, and Medicaid. ORS works forward from this point to achieve payment of the claims. Because ORS works on a contingency basis, the hospital pays nothing until the claims have been overturned by ORS and paid to the hospital.
A/R Management- ORS will assume Accounts Receivable responsibility for each claim after the specific amount of time, determined by the hospital, has passed for the claim. For example: After 120 days of billing, if the hospital does not collect on a claim, ORS takes over the collections process for the claim. This includes all accounts; Medicare, Medicaid, Commercial, Work Compensation, Tricare, etc. By giving older accounts to ORS, the hospital can then focus on the other 90% of its A/R and cash flow. ORS focuses on the older, more difficult, account collections. Again, ORS works on a contingency percentage of the cash brought into the hospital.
Self Pay- ORS conducts all self pay collections on site at the hospital. This work method is a much more cohesive way of collecting self pay dollars when compared to sending the accounts to an outside agency based off campus. It improves customer service and customer value: customers appreciate being able to come to the hospital to discuss and/or pay their bill. An advantage of this self pay program is that any insurance found by the ORS employees is given back to the hospital at no cost. The hospital can file the insurance and collect the cash without having an ORS fee attached. Once again, ORS only charges a contingency percentage on the cash brought into the hospital.
Third Party Underpayment Projects- ORS will go back through accounts 2 years from the time the project is started. Copies are obtained for all of the hospital’s commercial and managed care insurance contracts for this time period. ORS will look at all inpatient and outpatient claims that are over $500. Through collaboration with the reimbursement employees of the hospital, they work to find the weights, base rate, general medical education, wage index, etc. for Medicare, to ensure that the Medicare HMO’s for this time period are being paid correctly. If claims are found that were paid incorrectly based on the contract terms, ORS will re-file the claim to get the insurance company to pay the hospital correctly.
We also have experience in Computer Conversion Projects and Staffing, Credit Projects, Interim Management Jobs, and Consulting. We provide a well trained and competent staff to handle these services.