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RulePro® can immediately identify the proper phone number to call and instructions to follow to help assure that full reimbursement is received.
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Background
The growth of prospective payment systems, managed care, capitated contracts, and benefit carve-outs is presenting provider organizations with new management challenges.
Healthcare organizations across the country must now comply with an increasing number of insurance certification and authorization requirements--before services are rendered. In addition to identifying certification-related requirements, follow-up must occur to assure that all required activities have been completed.
Multi-Faceted Needs to Identify Certification Requirements
Healthcare organizations must be equipped with the capability to identify patient insurance requirements before services are rendered.
Patients must be aware--before treatment--what certification requirements exist so they can make informed financial decisions regarding non-authorized services.
Physician offices should know whether services they are ordering for their patients require authorization and/or will be reimbursed--and should notify the patient accordingly.
The RulePro® Solution
RulePro® can be used in outpatient registration, admissions, patient financial services, physician offices, and/or billing areas to:
- Enter and organize the ever increasing number of insurance certification requirements.
- Identify insurance certification requirements for each patient based upon a few data elements that are entered into RulePro®.
- Control the process to assure that all certification-related activities are performed.
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RulePro® for Insurance Certification