consulting services

In addition to Payment Review and Recovery, 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.

Litigation Support: Using our own in-house counsel or working with yours, Triage aims to overturn unjustified denials, recover underpayments and change bad-faith behavior. Through expert testimony, financial analysis, ongoing strategy and settlement negotiation, Triage assists clients in reaching favorable outcomes.

Clinical Denials: Using our own clinician, Triage reviews medical records to determine if the denied level of care, length of stay, service or admittance was, in fact, justified. With clinical justification, Triage appeals the denied claim with the health plan’s medical staff until the claim is resolved.

Medicare Review: Using similar audit techniques for our Managed Care Payment Review, Triage’s audits of Medicare accounts have recovered millions of dollars for our clients. We take all the necessary precautionary steps to ensure that the underpayments are fully supported and Medicare-compliant before any rebills are made.

Revenue Cycle Consulting: Triage provides a detailed examination to locate where along the revenue cycle, beginning with patient intake, mistakes which adversely impact revenues are occurring. Once we have pinpointed the flaws, Triage consults with the client to implement permanent repairs.

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.

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.