If you have Managed Care contracts, there is one area that is often neglected because your Managed Care Application does not handle it.

There is a significant amount of revenue you may be missing!

Managed Care is all about paying claims. What is missing is the Receivables component that takes care of billing back to the HMOs all the Rebillable claims – claims that are the HMO’s responsibility due to contractual arrangements (Insured Services) or due to retroactive termination of members (Eligibility Guarantee). Another billable component is Stop Loss or Enrollment Protection, which may be carried by the HMO or an insurance company.

At LCS, we have been solving the rebilling puzzles for more than 20 years!

We have developed a module that takes care of all aspects of Rebilling – from identifying the billable transactions to processing, billing and keeping track of them so they can be re-billed until they are paid.

Best of all, you can benefit from this module at no up-front cost to you!

The module is available for licensing, or you can leave all the work to us, and we will do all the rebilling for you. We get paid on what we collect, so there is no up-front cost or risk to you (1 year minimum contract on this offer - call for other options).

Most Managed Care software packages do not really address  the rebilling needs of an IPA, Medical Group or MSO such as: Eligibility Guarantee, Stop Loss, Third Party Liability, Insured Services, Pre-Existing Pregnancies, etc.

Some reports are generated, but these contain a lot of extraneous data and reduce the job to a mostly manual process. They also do nothing about keeping track of the amounts billed and ensuring that they are rebilled until they are paid.

Is this you?

Currently, rebilling is probably done via queries from your system, and the data is downloaded to reports and managed on spreadsheets or a PC database. The process is very time-consuming both in the query running time and the staff hours needed to identify billable transactions and maintain it. It is also error-prone, as a spreadsheet does not enforce any kind of data integrity.

Once transactions have been billed, keeping track of what you have billed is cumbersome since the data resides in different places. Billing again for what hasn’t been paid or asking for more reimbursement is difficult and so time-consuming that it is not being done. Responding to requests for more data is also harder than it should be.

In addition to all this, most payors minimize reimbursement by delaying, rejecting or asking for more information, knowing that most groups will write it off rather than respond because they are not equipped to handle it.

Therefore, since the current process is a series of ad-hoc manual steps, it is quite likely that only a fraction of the recoverable dollars are being collected, and you are spending too much time in the process.

Or, considering the above, you may have given up on rebilling altogether!

There IS a Solution …

Finally, an integrated package that is specifically focused on maximizing recovery with as little manual intervention as possible!

·         Claims and Enrollment data is imported from your managed care application – no manual entry!

·         Billable transactions are identified based on user-defined parameters

·         Different types of claims, statements or reports can be generated

·         All transactions are tracked, reported and rebilled until paid

·         Insufficient reimbursement can be easily billed again

·         Payments are applied on a line-item basis

·         Global payments can be easily applied and automatically distributed

·         Follow-up queries from the payors can be promptly answered since all data is at your fingertips

In short, the Rebilling Maximizer can significantly enhance and streamline the recovery process by:

·         Reducing manual effort

·         Increasing cash-flow

·         Maximizing recovery

There is a significant amount of revenue that is rightfully yours which is probably not being recovered. The Rebilling Maximizer can help you manage the recovery process with a minimum of FTEs.

The module is focused on doing one thing, and doing it very well. It can have a direct impact on the bottom line and a huge Return On Investment  (your CFO will love it!)