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The Problem. Many denied accounts become ineligible for appeal (untimely) before the hospital can effectively review the case and follow the complete appeal process.


In a recent analysis of client placements ARMC discovered that as many as 50.3% of all denied accounts were untimely, yet had not been reviewed by the hospital in months. 


ARMC has designed a 4-step Denial Management “Safety Net” Program with “fail-safe” that allows hospitals to more effectively review denied accounts and collect unexpected cash.

  1. ARMC monitors all denied accounts. Accounts coded "All Efforts Exhausted,“ “UM agrees,” etc. are pursued by ARMC immediately.
  2. All other claims that have not been worked by in-house staff for 90 days or greater are identified by ARMC and submitted to the hospital for approval for ARMC to assume responsibility.
  3. ARMC reviews contract terms – accounts within 60-90 days of becoming untimely are identified by ARMC and submitted to the hospital for approval for ARMC to assume responsibility.
  4. The hospital always has the final say on which accounts are worked by ARMC – but all accounts will get two sets of eyes, and no case will “fall between the cracks.”

Benefits:

  • Cash – recover lost revenues.
  • Compliance – ensure payments are in accordance with managed care contract terms.
  • Collaboration – access additional resources without the risk of redundant work. 

A recent NJHA study estimated that over 80% of denied claims never receive a second level appeal!

Why ARMC for Denials?

  • We have years of experience and excellent references.
  • ARMC uses an automated follow up system.
  • Our analysts are provided with simultaneous access to billing information, document imaging and other key resources.
  • We track the complete denial management process, identify trends, and report them to you the client.
  • ARMC identifies work standards required, then routes denials to the appropriate work queue for appropriate follow up.
 

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