Triage offers these areas of consulting expertise:
Contract Analysis and Negotiations
Triage advises clients on the language, financial analysis, negotiation strategy, and other aspects of contract negotiation. We help you make your managed care contracts easier to administer and in line with industry best practices.
Using our in-house clinical staff, Triage reviews medical records to determine if the denied level of care, length of stay, service, or admittance was justified. With clinical justification, Triage can then confidently appeal the denied claim, and engage the payer’s medical staff until the claim is resolved.
Revenue Cycle Consulting
Triage provides a detailed examination of the entire revenue cycle, beginning with patient intake, to determine where design flaws and operational errors adversely impact revenues. Once pinpointed, Triage works with the client to create and implement permanent repairs.
Capitation Risk Pool Audits
Our risk pool analyses have saved our clients tens of millions of dollars in liabilities. During a project, Triage reviews capitation revenue and reinsurance recovery. We examine the DOFR (Division of Financial Responsibility), relevant managed care contracts, and claims charged against the risk pool. 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.
Education & Training
To help our clients more efficiently recover underpayments, Triage conducts case study training and education. Participants include analysts, billers, supervisors, and directors of patient financial services and contracting departments.
In addition, Triage clients are invited to our private conferences, such as Clinical Breakthroughs and Legislative and Regulatory Updates.
Silent PPO Review
Your facility carefully negotiates reasonable discount rates to health plans – those who deliver guaranteed volume to you as a preferred provider. But many non-contracted payers cut corners – they improperly shop around for discount rates after their member receives treatment, without ever having channeled that business.
Triage’s Silent PPO Reviews have recovered millions of dollars from plans who try to take improper discounts. Triage not only recovers the cash – we review hospital procedures and contracts and recommend ways to reduce this pernicious behavior. We provide training and education about verifying and documenting benefits, improving internal controls, and ensuring that your contracts protect you from Silent PPO risk.