MULTIDISCIPLINARY PERSPECTIVE
Trilogi’s multidisciplinary perspective takes us beyond being a basic revenue recovery service. Our blended teams of clinical experts, attorneys and financial analysts understand how insurance, billing and collections practices, technology and decision making in each area affects your revenue cycle.
In addition to assisting your organization with immediate revenue recovery issues, our collaborative team approach helps you improve your organization’s knowledge and capacity to implement practices to optimize payer response from the start.
CLINICAL
Decisions made by case managers and hospital staff while patients are in the hospital often result in contested or non-reimbursable charges. The highly experienced clinicians on our teams provide value-added insight with our services, to educate case managers and staff of pitfalls and to implement best practices and procedures that optimize the revenue cycle. Our team helps you reduce delayed or denied payments due to such issues as:
- Medically necessary
- Length of stay
- No authorization
- No pre-certification
- Level of care issues
- Delay in treatment
- Inpatient v. outpatient
LEGAL
Our attorneys specialize in state and federal regulations related to healthcare and insurance. The insurance companies have a team of attorneys on their side guiding the company through the regulatory maze. We serve as advocates on your side of the table. Trilogi’s attorneys know the legal obligations and restrictions of payers that your staff may not realize. Therefore, in addition to understanding and interpreting contracts, we can be most effective in eliciting payer compliance via the phone, through attorney/clinician-written appeals, and in pursuing allowable penalties. Our goal is to quickly recoup denied claims due to issues such as:
- Terminated coverage
- Preexisting condition
- Rescission
- Timely filing
- Non-covered benefit
- Contract term disputes
- Usual and customary
- ERISA self fund plan delays
FINANCIAL
Our revenue recovery experts are well trained in the billing and coding requirements of Medicare, and ”how to be a ‘collector’ and not a ‘status taker’”. Our teams learn early on how to escalate issues to supervisor and management representative at payers and government entities in order to effectuate timely and accurate resolution to delinquent claims. Our analytical acumen in hospital-side and payer-side accounting practices, ethical policies and procedures, and commitment to accuracy assures timely resolution of issues involving:
- Billing/coding
- Coordination of Benefits
- Contractual underpayment
- Claim delays