Flexible solutions for all your payor reimbursement needs
We take the headache away from you, reducing the need for highly specialized experts in complex claims and letting you focus on doing what you do best, helping people.
YOU HAVE AN OUT-OF-NETWORK PROBLEM - YOU JUST DON'T KNOW IT
Insurance companies use a variety of questionable tactics to limit reimbursements on out-of-network bills to only 25% to 50% of billed charges. With extensive knowledge of out-of-network payor strategies, Collect Rx has developed a unique approach that works alongside your billing team to optimize out-of-network payments, “reasonable and customary” rates and re-pricing out-of-network bills.
Collect Rx combines this expertise with its proprietary CRXIS™ Business Intelligence Engine. CRXIS includes sophisticated data and analytics tools populated with information from the more than 2,100 providers across the nation who have maximized their reimbursements with Collect Rx.
The Collect Rx Pre-Payment Negotiation Service addresses the situation when the insurance company seeks to negotiate a settlement on an out-of-network bill after services are provided but before the insurance company makes a payment. When the provider receives a request to negotiate, the provider refers it to Collect Rx.
Out of Network
The Collect Rx Post-Payment Appeals Service addresses the situation when the insurance company re-prices an out-of-network bill down to a very low amount based on its determination of what is “reasonable and customary,” or doesn’t pay at all because the claim is denied or unreasonably delayed. Collect Rx then challenges the insurance company’s decision with a rigorous appeals process, which includes presenting the strongest facts and arguments backed by proprietary data and analytics.
Because leveraging ‘usual and customary’ data is the single most impactful thing you can do to improve your reimbursements for out-of-network, CRXISelect lets you tap into the number one source of out-of-network reimbursement data, Collect Rx. Let us identify your out-of-network claims that have the highest probability of returning additional payments. Then you choose – either you work the cases or we can, or both. Feel confident that you are getting the most for every claim, every time.
Revenue Cycle Management
Collect Rx’s innovative technology, processes, workflow, data-driven approach, and unique payor-side knowledge put you in the driver’s seat, ensuring that for every claim, you receive the highest reimbursement rates, every time. We help keep your operating margins healthy with data, insights, and optimization of every claim in your revenue cycle, every time.
Collect Rx’s results-driven revenue cycle management, including workflow optimization, technology, data analytics, and unique payor-side knowledge, helps our clients significantly increase collections and manage A/R.
Medical coding can be a challenge, particularly for providers with complex claims or a higher denials rate. Guideline changes and the competitive staffing market issues can cause disruption to your revenue cycle. Let Collect Rx’s trained and tenured coding staff ensure you maximize your reimbursements, minimize costs and get paid the first time.
For practices with complex claims, accuracy and timeliness are key to achieving the highest reimbursement rates. Collect Rx claims scrubbing and charge entry and reconciliation are built to ensure you achieve the highest first pass acceptance rate and optimize your clean claims, resulting in the highest reimbursements.
Collect Rx will work with you to generate patient statements for those who have an outstanding liability after their insurance carrier processes their claims. We work to ensure patients understand their obligation and are provided timely reminders of outstanding bills.
Payor Collections & AR Follow Up
When maximizing revenue from payors from underpayments and denials is critical, Collect Rx’s Payor Collections & Accounts Receivable Follow Up solutions are the answer. No matter your claim type, Collect Rx works across all payors to ensure that every claim is reviewed, denials and underpayments appealed and the first and additional payments reconciled to ensure that you are getting the payments you’re entitled to, on time and accurately. We’re experts in managing denials, collections, and reconciliation of additional payments, making sure that you get the highest reimbursements possible.
We work to ensure timely and accurate payments by monitoring status of claims and contacting the payors to identify the current status of the claim and determine if anything is preventing the payor from making a payment, and correcting issues.
We conduct a complete review of all denied claims and undertake actions to secure payment if possible or recommend and complete adjustments on accounts as warranted.
Out–of–network Negotiations & Appeals
With extensive knowledge of out-of-network payor strategies, Collect Rx has developed a unique approach to optimize out-of-network payments, “reasonable and customary” rates and re-pricing out-of-network bills.
Payment Posting & Balancing
Collect Rx will post all incoming insurance ERA’s and client shared EOB’s as well as any patient payments.
If you have legacy accounts receivables that you need reconciled, our A/R cleanup solution is ideal. Researching, appealing, and reconciling your outstanding A/R, we will identify potentially collectable accounts and pursue payment or recommend the appropriate closure so you understand your outstanding claims and get to zero balance quickly and cost-effectively.
Let Collect Rx’s payor reimbursement experts help you maximize payor reimbursements, reduce days outstanding and optimize your staff’s time, energy and focus.
Not sure how to leverage out-of-network to maximize your revenue? Let our experts work with you to identify payors, claim types, procedures and processes that will let you strategically support your business plan.
Complex claims require a level of expertise that Collect Rx can help you attain with our RCM Best Practices consulting, covering patient intake, coding, charge capture, billing, and process adjudication.
Let Collect Rx guide you as you develop your payor reimbursement strategy to help you build a robust end to end process that maximizes payor collections.
Revenue Cycle Analytics
CRXIS Analytics Solutions for RCM enables you to analyze the key areas of your Revenue Cycle and identify opportunities for improvement and increased efficiencies. CRXIS Analytics lets you identify trends that have the greatest impact on your finances and operations.
Measures the effectiveness and efficiency of your billing operations and enables your team to address root cause deficiencies and improve profitability
Provides a comprehensive insight into the total charges and the encounters and the procedures that generate the most revenue
Hands on data that allows you to design an analytics-based Collections Strategy
All the metrics you need to identify delays that prevent efficient and timely bill production and submission
Provides insight into root causes for denials and recommendations to work the denials and optimize reimbursements/minimize revenue loss