To work in tandem with the Client Hospital in-house RCM team (IP Support); on a non-invasive but immediate basis, to reconcile 835 to 837 data to find denials, underpays, and presumptive zero –balance (submission errors that can occur due to mis-keying, erroneous codes, for example), and to analyze appeals and denials for real time or follow up validation, and then resubmission for payment. We anticipate a processing fee that appears to be about ¾ of 1% of non-Medicare/Medicaid Revenue. In point 3 below we share an approach that, on a net basis, brings the cost of the GCA IP support from an element of cost to an element of profit.
As appeals are abandoned by the in-house team, those new (along with all prior) zero-balance accounts be assigned, forthwith, to GCA for it to begin its analysis and recovery process. We understand there is a hiatus between first knowledge of an appeal or denial, and final decision to zero-balance any one account. We also understand there is a 28 day right to respond that must expire before Hospital loses rights to further appeal. Without in any way jeopardizing the hospital’s rights, the timeliness and cleanliness of the assignment to GCA is highly determinant of timely recovery by us. So we need accounts quickly and we need them assigned. Moreover, we need to establish a protocol for negotiation and settlement on rights to money that are unearthed by GCA; we understand and sympathize with the fact that a provider’s interest in any one negotiated settlement might not mesh with ours, and we are prepared to respect the provider’s primacy in the matter as long as we are able to establish a protocol by which GCA is reasonably compensated.
Consistent with the AI strategy of increasing efficiency in part through cost containment, we propose a rebate of money we earn from our share of zero-balance accounts recoveries on the client provider’s behalf. The amount of the rebate will, all else equal, be the subject of negotiation; but we feel it should be a percentage of our actual segment Revenue (ease of calculation), limited to 100 percent of the IP fee ………..that means provider IP payments to GCA will actually net to zero for the foreseeable future. Over the longer term, as zero-balance recoveries wane due to systemic improvements in initial claims filings, the very moderate IP charge will be the only cost remaining in the provider’s relationship with GCA.