Resources

Check out our reservoir of information related to check recognition and healthcare payment technologies. We frequently update this section with the latest news, trends, and analysis of the banking and healthcare industries.

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Platform Modernization

Both the financial and healthcare industries are undergoing modernization initiatives in check payments and remittance.  See how OrboGraph is using AI, self-learning and deep learning models to drive innovation in these industries to deliver workflow automation.

Platform Modernization

Modernizing payments in the banking and healthcare industries

AI, Self Learning & Deep Learning Technologies

Optimized AI and deep learning models for the automation of check processing and healthcare posting

Operationalizing AI & Self Learning in Checks

Revolutionizing check processing and fraud prevention for the banking industry

Delivering Healthcare Payment Electronification

Increased accuracy levels, decreased error rate for healthcare payments posting

Product Videos

See how each product/service module of OrboAnywhere and OrboAccess delivers value from our check and healthcare payment platforms

Corporate Video & Podcast

See and hear how OrboGraph incorporates AI, deep learning and self learning technologies into its product suite

Healthcare Payments

OrboAccess automates remittance and payment posting as well as enables full research and business intelligence analysis for RCM companies, clearinghouses, billers, and providers.

Access EOB Conversion

Delivers EOB/EOP electronification with information intelligence via AI and deep learning technologies

Access Correspondence Letters

Extracts posting data and tracks reimbursement progress via workflow management

Access Payment Reconciliation

Streamlines the reconciliation process of ERA, ACH, EOB and checks

Access Patient Payments

Automates patient payments for posting

Access Denial Intelligence

Spotlights trends in denials to reduce receivables via prevention

Healthcare Payments Automation Center

Scalable, reliable, flexible cloud-based hosted data center on Amazon Web Services (AWS)

Check Processing

OrboAnywhere automates paper originated payments (i.e. checks, money orders, drafts) and remittances for balancing and posting while reducing risk and losses in the areas of check fraud, payment negotiability and compliance.

Anywhere Fraud

Transaction and image analysis for on-us and deposit fraud detection of counterfeits, forgeries, and alterations.

Anywhere Recognition

Divergent multi-engine CAR/LAR, ICR, OCR & AI check recognition for the Omnichannel

Anywhere Validate

Validate payment negotiability of paper originated items

Anywhere Payee

Match, read, and validate payees for risk and operational workflows

Anywhere Positive Pay

Payee name verification of business checks using issue files

Anywhere Compliance

Mitigate risk in check payments for OFAC, BSA/AML, UCC, Reg CC, and KYC

Restrictive Endorsement

Automatic validation of restrictive, mobile and non-restrictive endorsements

Traditional Products

Based on the Accura XV platform

Find Out Where You Stand Today on This Controversial DME Prior Authorization Rule

Becker’s announcement on CMS’ DME prior authorization rule came a while back, but CMS’ stance on prior authorization is likely still causing denial issues for your facility today.

The Backstory

Just as 2016 was about to round the corner, CMS issued a rule requiring prior authorization before Medicare would reimburse DME that had been found to be subject to improper and fraudulent payments. HHS’ Office of Inspector General and the GAO made a point of highlighting financial concerns around:

  • Wheelchairs
  • Prosthetics
  • Orthotics

Their concern wasn’t unfounded — the previous October, the Council for Medicare Integrity had reported a 53.1 percent error rate for DME billing during FY 2014 amounting to $5 billion in improper payments.

The rule was expected to save Medicare $580 million over a decade, so it’s worth asking where things stand today.

 

The Update

In June of this year, CMS’ Center for Program Integrity released this document, covering the prior authorization process for specific DME and introducing plans for the “narrowly tailored” DMEPOS Prior Authorization Program, committing itself to learning from both patient and provider experience, and encouraging feedback as a part of the process.

When you dig into the details, you’ll see that it covers which power wheelchairs require prior authorization (K0856 and K0861), explains why wheelchair accessories aren’t included, and outlines documentation requirements as well as the impact on patients.

The presentation additionally provides resources including:

Insight into the authorization process and the Prior Authorization Process decision flowchart (slide 22) are likely the most useful sections of this presentation but only if you fully understand the impact that DME authorization denials have on your facility’s revenue cycle.

Getting pinpoint insight into denied claim trends around DME prior authorization denials will require a sophisticated business intelligence tool that can provide your denial managers the reporting they need. Access Denial Intelligence can provide that and more, so contact OrboGraph for a consultation today.

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