Blue Cross Revenue Strategies

The complexities of the Blue Cross Blue Shield reimbursement process create the need for a high level of expertise to help obtain appropriate payment levels. Our firm has that knowledge and experience to assist your facility in this complex process. Specific services include:

Cash Reconciliation Reviews and Appeals

The complexity of Blue Cross reimbursement requires a review of ALL reimbursement-related documents that come from Blue Cross.

Our experienced consultants will review your annual Cash Reconciliation  to validate you are receiving all of your reimbursement.  A detailed analysis of your Front Sheet claims data and adjustments will be performed to ensure accurate reporting on the Cash Reconciliation.  Potential issues identified will be documented for filing of appeals along with a reporting of potential Rate Model impacts.  Over the past 4 years, The Rybar Group has successfully appealed over $11 Million for our clients.

What is .04% of your Gross Outpatient Charges?  That is our average recovery.

Your Header File Rate letter should also be reviewed to ensure that reimbursement is not lost due to improper application of updates, prior period Models and the carry forward of Market-based Pricing Factors all of which affect your reimbursement.

Blue Cross reimbursement is very complex and requires more time than many hospitals have.  Don't miss out on the reimbursement you should be receiving.  Call our team of knowledgeable and experienced Blue Cross consultants today to learn more about these opportunities.

 

BC Attestation Audits

Accuracy in the Blue Cross Price Attestation process is key! The reality is that the percentage reported on the attestation form can have a dramatic impact on a hospital's cash flow for years to come.  hospital's that under attest to their actual price increase can be subject to an audit and recovery of funds by Blue Cross.  These unexpected take backs can be detrimental to a hospital's cash position.  Hospitals that overstate their price increase can cost themselves thousands of dollars in reimbursement.

From Cost-based Charge Audits to Peer Group 5 Attestation Reviews, The Rybar Group has the experience and resources to ensure the analysis is accurate.

What we'll provide...

  • Detailed comparison of chargemaster level services
  • Analysis of volume changes
  • Assessment of service line changes
  • Analysis of attested charge increase

We have successfully defended take-backs for hospitals of all sizes, from the large health systems to the small rural hospitals.  The Rybar Group will work with you.

 

Blue Cross Interim Reimbursement Validation

Your ANSI 835 payment voucher files provide the claims data  used to calculate your Final Cash Settlement.  The Rybar Group's validation process can answer each of the following questions using your payment files:

     BIP Review

  • Is your BIP payment correct or can you expect another review?
  • Are you confident with the BIP review you just completed?

     Preparing for Audit

  • Are your contractual model assumptions valid?
  • Are your Logs capturing all activity?

     Final Cash Settlement

  • Would you like to have your preliminary cash reconciliation 6 months earlier?

     Market Based Pricing

  • Is it Budget neutral

Take Control of your Blue Cross Reimbursement

What The Rybar Group will provide...

  • Quarterly Summary of your Blue Cross book of business
    • Admissions
    • Case Mix Index
    • DRG Weights
    • Covered Charge Totals
    • OP Screen Totals
    • Voucher Payment Totals
  • Audit Support for your Blue Cross contractual model
  • Quarterly testing of your contractual model
  • Reporting of your Market Based Pricing impact
  • Tentative Blue Cross settlement amount

 

PHA Model and LOU Reviews and Negotiations

Blue Cross Model Reimbursement Methodology is based on a collection of financial and statistical data.  The Rybar Group has years of experience compiling this data into useful information within your Model.  Our consultants understand the importance of each component of your facility.  From your Uncompensated Care expenses to your attested price increases, decisions you make can have a long lasting impact on your Blue Cross reimbursement.  We offer a detailed analysis of the Blue Cross Reimbursement Model with the goal of optimizing your facility's rates.

Many hospitals have special negotiated rates with Blue Cross called a Letter of Understanding (LOU).  These LOU's should be evaluated each year to ensure they are providing the intended benefits to your organization.  Our team of reimbursement specialists will work with you to understand the needs of your facility and make sure your rates provide the optimal reimbursement.

 

Peer Group 5

While Blue Cross reimbursement to Peer Group 5 hospital's may seem simple, the reality is that it is very complex.  The Rybar Group's team of Blue Cross reimbursement experts understands the complexities of the peer Group 5 Reimbursement Model and will provide you with the knowledge to optimize your reimbursement.

As a Peer Group 5 Hospital, your pricing strategy will have a direct impact on your total Blue Cross reimbursement.  our team of consultants has years of experience analyzing pricing strategies.  We can offer a strategic pricing policy to optimize your cash flow while maintaining compliance with your attested price increase.

Have your volumes been declining?  You may be eligible for additional reimbursement from Blue Cross.  The Rybar Group will review your statistical and financial information for potential opportunities.

 

For more information about your facility's Blue Cross reimbursement opportunities, contact one of our Blue Cross consultants:

 

 

 

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