Health Schemes Management
Hexcell Health is set up with the aim of providing sustainable solutions to challenges faced by hospitals in handling the Health Insurance and Health Schemes that sponsor a section of the population taking treatment without upfront payment.
To ignore the insurance schemes and other Health Schemes will amount to disregarding a significant revenue stream for the Hospital. This is especially true in the background that the Government of India is sponsoring Social Health schemes collectively with the involvement of state governments. But running and managing them can a throw a number of challenges to Hospitals among which a key issue could be the timely collection and follow up of receivables. If managed efficiently, it could be a fabulous stream of revenue. It could be a huge cash flow issue, if not.
Many a hospital in Kerala is at the receiving end with sizeable outstanding dues from such schemes and several hospital Associations have notified the Government that they would be compelled to move out of such schemes in future. This is indicative of the magnitude of the issue.
Managing social schemes like RSBY, ECHS, and ESI and Health Insurance can pose serious challenges to hospitals in terms of handling paperwork and expertise required for claim processing as well as following timelines specified under the Agreements. This leads to claims getting rejected partially or fully even, or can result in delayed payment of claim amount, affecting cash flow. It can affect the cash flow and more seriously, the bottom-line itself due to unfair rejections and delay in the settlement of treatment bills submitted to the Payers of the Schemes. As per industry reports, nearly 20 to 30% of raised healthcare insurance claims are rejected or denied.
Tying up with Hexcell Health will offer the Hospitals the confidence and capability to efficiently focus on their own larger issues in improving overall patient care quality and scaling up healthcare business.
Leaving such work to the professional and competent handling of Hexcell Health will free you from the bother of chasing the collectibles and enable the Institutions to concentrate on their core area of extending quality patient care while improving the cash flow through the timely collection of dues.
The rejected claims can be contested in a decisive manner and the receivables improved substantially on the back of methodical and professional approaches, which, we assure, we are capable of.
Hexcell Health offers a full suite of services targeting MANAGING DENIED HEALTH INSURANCE CLAIMS that include, Claims status checks, Resolution of denied claims, preparing appeal letters etc. – all done with a single-minded purpose of collecting all amounts that you are entitled to, and due to you, for the medical services rendered.
Our expert team is capable of tracking denials, identifying root causes and executing denial management prevention strategies. As much, it is important that your key personnel in a variety of departments and physicians get appropriate feedback on the trends and findings. Medical practices which refuse to understand or ignore these are most likely to see unfavorable results, leading to writing off a huge sum as unrecoverable, which otherwise was rightfully yours.
Undeniably, our team have a matchless track record and domain experience of managing over a lakh of claims and, we have decided to roll out our services for the benefit of healthcare sector, especially in the background that the new Health Insurance Scheme announced by the Central Government is about to cover a mammoth 50 Crore Indian citizens with a benefit limit of Rs.5 lakh coverage per family.
Managing Denied claims
Our object would be to take up these issues, streamline the process and help the hospital to get the payment at the earliest. For this we are planning to do the same in five stages for your rejected Files:-
To study each rejected file thoroughly and do medical claim scrubbing. In this process, the following data are subject to verification, viz.
- Patient/Provider data.
- Insurer/Insured data.
- Medical Necessity for admission.
- Actual procedures performed, mapped to the diagnosis.
- Age and gender specific procedures.
- Data validated against payer conditions.
To prepare detailed claim note for each rejection/delayed claims with medical analysis and challenging their decision to deny the claim. All valid points for the eligibility of claim reimbursement will be suggested here
To present organized data scientifically and methodically to counter effectively and successfully before the Payer’s rejection committee.
Pleading the authorities for considering the claim again with our arguments for reconsideration.
Periodical and target oriented liasoning work is undertaken to follow up the claim submitted with the respective authorities.
To represent on behalf of the hospital and present our case before the rejection committee/Appellate authorities on rejections.
- Are you an insured who feels wronged for your claim having been rejected fully or partially?
- Are you a Hospital that is unable to manage its bulging unpaid-insurance-billing?
- Are you a Hospital which wants the health insurance/ health scheme billing to be professionally handled for optimal and efficient management of revenues and dues?
- Are you a Hospital that needs special services like auditing/accreditation services, medical coding etc?
Team deployed from our end
- Medical professionals well versed either fields of medicine and insurance.
- Health Insurance Claim professionals with substantial work knowledge and experience.
- Experienced Professionals from health insurance domain.