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

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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

These “Far-Out” Denials Can Cause Real Audit Problems

You might have heard of some of these “far-out” denials from an HME NewsPoll, but they really are worth a review…

…a Medicare prescription denied because it was “written by a girl.”

…an agency had a beneficiary “listed as dead, then alive, then dead again.”

…multiple providers receiving denials for wheelchairs intended for amputees and paraplegics, one of which was for a power wheelchair because the patient “also owned a truck.” (They apparently missed the fact that a truck wouldn’t work to navigate the patient’s apartment.)

The list goes on with several respondents frustrated that denials were flagged simply because contractors were overlooking information. Craig Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment shared his experience. “A RAC audit stated the patient’s weight was missing when it was there in three different places.”

There were also complaints of claims being denied for not adhering to Medicare rules—one provider reported a denial because a doctor’s credentials and date were not entered on the chart notes next to his signature. The Medicare Program Integrity Manual though doesn’t require this.

 

The Audit Problem

While some of these are good for a chuckle, they do present a clear threat for providers—they are the types of claims that can make the audit process unnecessarily difficult and perhaps even trigger an audit itself.

This is especially true in light of CMS’s August announcement of a revamped claims review process that will increase scrutiny of claims submitted by providers with the “highest claim error rates or billing practices that vary significantly from their peers.”

As part of the growing “Targeted Probe and Educate” program the expansion will be provider and supplier specific from the beginning, meaning that providers who are already submitting claims that comply with Medicare policy should be relieved of some of the burdens of additional review.

Providers face a potential three rounds of review by a MAC, and individualized education will be offered after each round based on the results of the review. After round one, providers who fall into the moderate and high error rate categories will continue to a second round, with only those with high error rates continuing to a third.

Since low error rates help qualify providers for removal from the review process after any of the three rounds, low error rates should be a priority for any provider interested in minimizing the difficulty of their audit process.

The best way to get to those low error rates? Investing in a system that can analyze and identify denial trends around Medicare claim errors. Access Denial Intelligence offers that exact benefit along with a highly intuitive user experience that can be used across the provider and at multiple levels of management.

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