WFS Is Your Partner In Receivables Management

Our services are specifically designed for managing the Healthcare Revenue Cycle. They range from Day 1 Billing, to Follow up for patient pay portions, Follow up on aged insurance liability, to Customer Service Bureau, Web Help Desk, Denial Management, Special Projects, Systems conversion, and proactive consulting with all of our clients.

OVERVIEW
PROJECT SCOPE

We have over twenty-five (25) years of experience with managing hospital self-pay and aged insurance receivables in geographically diverse locations for single hospitals and entire multi-hospital systems:

  • We can increase your cash recovery
  • Ad-Hoc Reporting and Data Mining (Free!)
  • Account Monitoring and Reporting (Free!)
  • Detailed reporting of all activities through webPHAMIS (Free!)
  • Receive invaluable "Value Added Services," including:
    • Web-based Patient Help Desk: Help-4-U.com
    • ePay: electronic payment
    • Address Scrubbing
    • Medicaid Batch Matching
  • Systems and Processes to ensure compliance with regulatory requirements
  • Conversion / Run Out support
  • Special projects
  • A customer service bureau with a toll free 800# for patients, open Monday through Friday, 8:30am-7:00pm
  • Ability to "connect" hospital and physician through data interfaces
  • Robust production facilities to support:
    • Patient friendly statement generation
    • Electronic call recording
  • Cloud based systems to ensure 24/7 access to information - guaranteeing transparency on all WFS activity
  • SSL-secured and PCI Compliant - ensuring PHI protection
  • Certified Third Party Billing Company
  • WBENC - National Women's Business Enterprise Certification
SUMMARY OF SERVICES

Automated Triage

Utilizing the power of our proprietary system, ARGIS (Accounts Receivable Global Information System), WFS can triage all accounts immediately to determine their status. Where there are accounts with allowances and no payments, we perform follow up with the insurance; where there are accounts with payments and no allowance, we pull the vouchers to ensure the account is properly posted. We can also check for accounts ‘stuck’ in insurance that should be moved to self-pay. By performing an initial triage automatically, we can ensure that account activity is 'kick started'.

Initial Review

Once the automated triage is performed, accounts are divided among the billers based on financial class and personnel expertise. Follow up is initiated via electronic look up on payer website or direct calls to insurers for claim status.

Bill/Rebill

Immediately upon determination of the status of the account, all billing and/or rebilling activity is performed. Where needed, hard copy claims, medical records, and replacement documentation is sent. Priority of billing/rebilling activity is based on a) aging of the account – where there is a danger of the account ‘timing out’, those jump to the front of the queue and b) outstanding balance.

Claim rejections

Any rejected claims from the follow up activity are analyzed, corrected (as needed), and re-submitted.

Appeals

Claims that are declined are appealed, where possible.

Secondary/Tertiary Billing

Once payment is posted, the account is reviewed for additional insurance for secondary/additional billing. Redacted EOB’s will be provided with the secondary billing as necessary.

Payments not received

For those accounts where payment is not received, we follow up with the insurance companies at least every thirty (30) days. For those non-governmental payers, patient involvement is also requested via outbound correspondence.

Patient responsibility after insurance

Patients are notified of their balance amounts. The self pay process includes customizable outbound letters and phone calls.

Unresolved accounts

WFS’ Project management reviews accounts where there has been no payment and no contact with the patient. This review ensures that WFS has performed all of its functions and every possible effort has been made to collect the money. Once past this review, the accounts are referred to the client for Bad Debt write off. WFS can forward these files in an electronic format directly to that agency, as needed.

WFS, as a full-service receivables management firm, approaches receivables management with the understanding of its place as part of the service-to-recovery cycle. WFS will actively process the selected accounts, and can provide you with reports to enable you to focus your activity productively and efficiently.

WFS understands that a 'self-pay' account is not always 'patient pay'. Through proactive and persistent patient/guarantor contact, insurance information is often obtained on those accounts initially classified as self-pay. Based on the methodology to be implemented, where insurance information is found, WFS' staff can bill the third-party through your system (to maintain a robust audit trail) and update your system so that future registrations will carry the correct information. Where no insurance is found, and the patient is unable to pay, WFS works proactively with the patient/guarantor to assist them in qualifying for Federal (e.g., Medicaid) or State (e.g., Charity Care) assistance.

In today’s complex world of reimbursement, claims submissions, denial management, the Affordable Care Act, and the myriad insurance plans and coverages, providers often need assistance in following up on outstanding accounts. The majority of claims can be submitted and paid but, as with any other process, 20% of the claims will require 80% of the effort to get them paid. This is where WFS shines – in providing support for the process once the claim becomes ‘high touch’. WFS provides additional staff support to access claims status, work denials, appeal claims, rebill with corrected information – that is, we do what needs to be done to get the claims paid!

WFS has years of experience with successful implementations. We work closely with our clients and put our experience to work for their benefit. We have interfaced with every major system and have no restrictions in working with any of them. We are committed to making implementation stressless and seamless – and we do!

Time frames for “go-live” are generally very short, but do depend on the resources you can commit to the process. All you will need to do is allocate IT resources to develop the data download and set it up as a regular process as well as provide WFS with VPN access to your systems. Our usual time frame for implementation is under 5 business days – once the data interchange piece is complete.

IMPLEMENTATION

We will need to:

  • Establish operational parameters
  • Resolve any IT transmission issues
  • Process test data transmission and validate data integrity
  • Finalize any modifications to our custom loaders
  • Agree on letter contents and timeline

WFS has years of experience with successful implementations. We work closely with our clients and put our experience to work for their benefit. We have interfaced with every major system and have no restrictions in working with any of them. WFS has established working interfaces – for both hospital and physician entities - with various versions of:

  • Epic
  • Soarian
  • SMS/Siemens
  • McKesson/HBOC
  • Quadramed
  • Eclipsys
  • Keane/NTT Data
  • Medisoft
  • Medical Manager
  • Perfect Care
  • Meditech
  • IDX
  • Cerner
  • DataARK
  • "home-grown"
  • and others

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