consulting services

In addition to Managed Care Payment Review, we also offer the following:

Workers’ Compensation Review: In recognition of the changing landscape for the treatment of workers’ injuries and the use of hospital resources, the nation’s states administer fee schedule patches and issue temporary band-aids, often annually. It is no wonder that workers’ compensation claims are difficult to resolve accurately. Triage has recovered hundreds of millions of dollars in underpaid Workers’ Compensation claims.

Contract Analyses and Negotiations: Triage advises clients on the language, financial analysis, negotiation strategy, and other aspects of contract negotiation. We ensure they are working with managed care contracts that are easier to administer and in line with industry best practices.

Silent PPO Review: Our Silent PPO reviews have recovered millions of dollars from offenders. In addition, Triage reviews hospital procedures and contracts. Upon review, we make recommendations for verifying and documenting benefits, improving internal controls, and ensuring contract prohibition of Silent PPO activity.

Litigation Support: Triage litigation support and consulting aims to recover underpayments and change bad-faith behavior. Through expert testimony, financial analysis, ongoing strategy and negotiation, Triage assists clients in reaching favorable outcomes.

Capitation Risk Pool Audits: Our risk pool projects have saved our clients tens of millions of dollars in liabilities. During a project, Triage reviews capitation revenue and reinsurance recovery. We compare charges to the risk pool to the division of financial responsibility and managed care contracts. We re-compute IBNR and the allocation of surpluses and deficits.

Together with the client, Triage meets with risk pool partners and helps negotiate the final risk pool settlement.

Continuing Education: In order to help our clients become self-sufficient in recovering managed care underpayments, we conduct training and education through a wealth of Triage case studies. Participants include analysts, billers, supervisors, and directors of patient financial services and contracting departments.

In addition, Triage clients are invited to participate in our annual Clinical Breakthroughs and Legislative and Regulatory Update conferences.