Meet RemedyIQ - Revenue Protection

Meet RemedyIQ

RemedyIQ is a boutique consulting firm empowering healthcare organizations and their leaders with the tools, insights, and data-supported root cause analysis to thrive. Collectively with over 200 years of experience in healthcare, we offer strategic advisory services, interim resource support, and revenue protection solutions to improve financial performance by reducing cost to collect, streamlining claims adjudication, and optimizing existing technologies and workflows.

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Revenue Protection

RemedyIQ’s revenue protection services are focused on improving your revenue cycle workflows and process drivers, provide clarity to A/R, enhance revenue, and manage cash flow.

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Expected Reimbursement

‍Provider reimbursement from payers is complicated and ever-changing with fee for service, capitation, bundled/episode-based payments, and payer reimbursement policies. Expected reimbursement is a workflow driver, data analytics source and productivity enhancer. When maintained properly, it serves as the first line of defense for providers to ensure they are reimbursed properly.

Benefits of accurate Expected Reimbursement:

• Revenue Cycle:  Drive better, more accurate workflows in Epic, capture more revenue, decrease credit balances and increased staff productivity
• Finance:  Expected Reimbursement feeds the income statement, budgets and balances sheets.   Accurate Expected Reimbursement improves AR valuation, cash targets and contribution margin reports
• Contracting:  Modeling, negotiations, payer performance, impacts of payer policies and contract interpretation issues

Our Certified Epic team members have deep industry experience in best practices for building and maintaining the most complicated contract structures. We offer expertise in both Physician and Hospital contract builds and offer projects to implement contracts, clean-up existing builds, maintain, and can step in to perform build. 

• Expected Reimbursement Optimization – RemedyIQ has a team of technical managed care experts that can identify errors in Expected Reimbursement build for negotiated commercial contracts and government programs to identify areas for refinement to ensure accurate Expected Reimbursement calculations for Finance, Revenue Cycle, and Contracting. RemedyIQ has the capability to provide technical direction to Epic-IT and Contracting teams or can perform Epic build independently with their certifications, which include Resolute Hospital Billing Administration, Resolute Physician Billing Administration, Resolute Hospital Billing Expected Reimbursement Contracts Administration and Resolute Physician Billing Reimbursement Contracts.
• Expected Reimbursement Maintenance – RemedyIQ has supported health systems with ongoing maintenance services to monitor contracts for performance, identify/resolve build logic issues, provide quality assurance for new contracts, track and implement fee schedule changes, and manage government factor updates.
• Interim Epic Resources – RemedyIQ has supported Epic-IT teams with certified Epic resources. 

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CDM Reviews & Strategic Pricing

Strategic Pricing is the comprehensive evaluation and recommendation of new CDM line-item pricing for existing CDM structures to better position providers with the market to optimize net revenue within the constraints of managed care contracts while achieving gross and net financial goals. RemedyIQ offers Strategic Pricing services in both the hospital and physician billing spaces to ensure your organization’s CDM is strong, compliant, and competitive.

• Strategic Pricing – RemedyIQ offers annual HB and PB CDM reviews along with targeted rate modeling to ensure a compliant approach to enhance your competitive edge.  Our reviews are based on data, managed care agreements and local area benchmarks and ensures compliance with industry standards, federal regulations and benchmarking data. We work with our clients to target a specific gross revenue lift (or neutrality) while maximizing the net revenue potential. Our deliverables can be hospital, department, payer and IP/OP-specific to cater our clients’ reporting needs.
• Specialized Pricing Projects – RemedyIQ can be a partner in a multitude of pricing project needs including CDM Consolidations for gross neutrality, new time-based charging intervals for service lines (Surgery, Anesthesia, L&D), new tier-based charges encompassing resource utilization (PACU, Endoscopy, Pain Management), or new bundled charges for L&D. We provide gross and net revenue calculations unique by charge code. These projects can be a great addition and potential net revenue lift to your annual targeted rate modeling reviews.
• Supplies Markup Modeling – RemedyIQ has the expertise to review a client’s current Supplies cost-based markup and propose multiple strategies to maximize net revenue.

Recovery Services

‍RemedyIQ specializes in identifying and recovering complex claims and denials. Our philosophy is as a partner, not vendor. We provide root cause reporting and recommendations to prevent revenue leakage and lost revenue while strengthening internal processes and workforce knowledge.

• A/R Recovery – RemedyIQ can step in and work specific payers or claims to accelerate cash, resolve A/R and decrease workqueues volumes. Our approach is tailored to the specific needs of your organization with the goal of resolution as efficiently as possible.