Accelerating Cash Recovery, Improving Revenue, Across the Value Chain

Today revenue cycle managers need to find better ways to improve patient satisfaction, contain costs, and engage patients at all lifecycle points. All industry stakeholders want better outcomes in areas from data accuracy and ICD-10 coding readiness to decreased denials, problem financial classes, and unworked balance ranges. HGS Revenue Cycle Management Services (RCMS) joins with our clients to find better outcomes in patient access, health information management, and patient financial services. HGS delivers working solutions for financial clearance, medical coding, and insurance claim resolution designed to improve net revenue, to reduce denials and bad debt, and to accelerate cash recovery. HGS's RCMS team has more than 1,000 BPO staff who deliver a range of services from our business centers in Princeton, New Jersey; St. Louis, Missouri; El Paso, Texas; Manila and Iloilo, the Philippines; and Bangalore and Hyderabad, India.

HGS RCMS has a proven track record of exceeding client expectations for financial clearance, coding accuracy, cash recoveries, and denial reversals, when compared to our clients' historic performance. We augment our clients' revenue management efforts in an ongoing supplemental role and during specific events that lead to pressures on cash flow, including patient accounting system conversions, process transformation and redesign efforts, staff turnover, and talent recruitment challenges. As a trusted,  forward-thinking partner, HGS Revenue Cycle Management Services delivers real, bottom-line outcomes—net revenue increases, reduced bad debt, and an optimized customer experience, with an overall commitment to compliance, security and quality—to next-generation, consumerism-focused healthcare providers and their customers.

How We Do It

Our suite of services include front-end Patient Access services; mid-cycle charge integrity, medical coding, and billing services; and back-end insurance claims resolution offerings, administrative and clinical denial appeals, and customer-driven self-pay early-out services.

Patient Access Support

  • Perform financial clearance activities in a manner compliant with hospital protocols and federal regulations.
  • Verify all required demographic data, insurance eligibility and benefits coverage, obtain authorizations/referrals.
  • Obtain current eligibility and benefits coverage using payer websites, IVR, and 270/271 transaction sets.
  • Define and measure key performance indicators for client and HGS operations.
  • Analyze 835 data for front-end denials to identify trends and performance opportunities.

Patient Financial Service Support

  • Drive ongoing collection of targeted aged insurance claims (such as claims aged>120 days) in a manner compliant with provider and regulatory guidelines.
  • Ensure high volume/low balance claims follow-up.
  • Provide system conversion support (such as pre go-live cash acceleration and/or wind down of legacy system accounts receivable).
  • Offer Workers' Compensation and Auto/Liability account management.

Health Information Management Support

  • Provide remote coding capabilities for all patient types using certified and experienced coders.
  • Ensure coding support with detailed analytics.
  • Support with robust Quality Assurance and Compliance programs.
  • Scale coding teams to adjust for seasonal and business demands.

Enabling Technologies

  • Proprietary Claims Management System (CMS) for automated work assignment.
  • Electronic eligibility and claim status inquiries using HIPAA 270/271 and 276/277 transaction sets.
  • Ability to leverage 835s for denial analytics and accelerated resolution.
  • Reverse interface capabilities to post follow-up notes and demand rebills to client systems.

Our Value

  • More than $6.9 billion in client accounts receivable are managed and $2.6 billion in cash recovered.
  • We have processed more than 60 million hospital, physician, and DME claims.
  • We have reversed more than 8 million zero-paid denials, resulting in over $950 million in recovered payments.
  • Cash recoveries exceed client baselines by an average of 21%.
  • Denial reversals and cash recovered on claims aged >1 year from discharge typically cover cost of services.
  • In total, 100% of clients surveyed state that they would use HGS services again.

"We were pleased with the recoveries, considering the age of the receivable we placed, but what really excited our team was HGS's deep partnership with staff and management. The 0% patient complaint score was a significant benefit of the HGS engagement. As a result of HGS's informative monthly reporting, we were able to address areas of opportunity and prevent future accounts from aging."

Leading U.S. Health System

Eliminate administrative denials by95%

HGS employed state-of-the-art analytics to achieve a
decrease in denied receivables.
Healthcare Professionals
Serving Members on behalf of Payers and Providers
Industry-Leading Compliance