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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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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.

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Modernizing payments in the banking and healthcare industries

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Revolutionizing check processing and fraud prevention for the banking industry

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

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

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Extracts posting data and tracks reimbursement progress via workflow management

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

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Automates patient payments for posting

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Spotlights trends in denials to reduce receivables via prevention

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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.

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

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

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Validate payment negotiability of paper originated items

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

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Payee name verification of business checks using issue files

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

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Automatic validation of restrictive, mobile and non-restrictive endorsements

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Based on the Accura XV platform

Newsflash: 90 Percent Jump in Uncollectable Denials in Just 6 Years

It looks like 2018 is going to be the year of denials and that’s exactly as foreboding as it sounds.

Becker’s article based on the Advisory Board’s survey revealed that denials written-off as uncollectable, costs the average 350-bed hospital $3.5 million annually; a whopping 90 percent jump from just six years prior. Compounding this challenge is that fact that in the last two years, successful appeals to commercial payors dropped from 56 percent to 45 percent. Things aren’t looking much better for Medicaid, with appeal success rates plummeting 10 points from 51 percent to 41 percent for the same period. Looking for your own analysis, take a deeper look into the survey results.

Are hospitals generally improving their revenue cycle processes? Of course, with notable results from POS collections. However, those front-end wins could be masking the increasing risks of growing denial write-offs and other inefficiencies for many hospitals.

And now for HME/DME market:

A look at the HME/DME market specifically reveals compounded challenges of varying denial rates. A full 21 percent of claims in this market fell under the eligibility umbrella, with Medicare leading the payer pack. Within that eligibility group, denial reason codes 204 (service/equipment/drug is not covered) and 27 (expenses incurred after coverage terminated) came in as the most common. On top of that, we saw a 2 percent jump in denials for oxygen and supplies from 2016.

James Green, National Partner, Consulting at Advisory Board highlights an opportunity for providers in the form of focusing on denials in a dynamic climate.

“With denials volume increasing not just for commercial payers but especially for Medicare Advantage, health systems need strategies to address denials proactively…The wide range of denials performance among health systems — spanning 3 percent of net patient revenue between high and low performers — amounts to a $10 million swing for a median 350-bed hospital. Appeals are becoming increasingly difficult, so health systems should focus on approaches such as improved documentation and authorization processes.”

What is the solution?

RCM leadership will need to hyper-focus on opportunities for improvement, one of which the survey clearly calls out; the high operational cost of denial functions. Advisory Board emphasizes the growing complexity of the mix of denial and other revenue cycle functions, suggesting they should likely be delegated to the oversight of a vice president. In order for operational improvements to be targeted, a strong analytics approach must be taken to identify, prioritize for, and act on proactive measures. That’s where Access Denial Intelligence comes into play.

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