Our Core Services

Healthcare Consulting

OSP’s team of experienced healthcare experts offers quality healthcare consulting services for providers and health plans. Our team includes experts on enterprise software platforms, US government programs, digital innovation, and business operations.

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Enterprise Applications

OSP is proficient and experienced in building robust enterprise applications to address your complex and sophisticated software needs and execute your digital transformation lifecycle. We have comprehensive customized tools to solve your healthcare challenge.

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Healthcare Solutions Enhancement

Optimizing the healthcare system is essential for better productivity and quality performance. OSP’s team of developers can enhance and upgrade the healthcare solutions in modules, security, or interoperability sections with new custom components.

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Dedicated Quality Assurance

OSP’s QA team can resolve the challenges of disrupted workflow and application safety. We offer assurance in product quality with multiple levels of quality testing, including usability, performance, localization, and security testing.

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Explore Denial Appeal Management

Denial management in healthcare is one of the most crucial elements that ensure steady cash flow and powerful revenue cycle management. Denial management services include identifying the key problems that cause claim denials, classify them based on cause & source, and develop an effective denial management software strategy.

We provide tailored denial management solutions that help to enhance their clean-claims rate, manage denied claims effectively and have proficient assistance in handling the appeals. Our healthcare denial management can help providers to identify and exact causes of denials to improve your clean-claims rate. It can streamline workflows for faster appeals and improved cash flow while lowering the cost of managing denied claims and the administrative burden. Resolving underpayments while reducing regulatory risks to keep the financial performance optimum is the primary goal of OSP’ tailored healthcare denial management systems.

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A well-defined advanced payer rule engine helps to track payer-specific rules for claim payments, identify their denial activity and recognize new rules. Defining claims qualification for each payer within the system can be made possible with a sophisticated payer rule engine. It can anonymously track these rules for each user base and automatically distribute current rules over the entire network.

OSP can build a custom denial management in medical coding that can assess your 835-remittance data to reveal the major reasons causing the claim denials. Our tailored healthcare denial management systems can analyze, track, and create intuitive reports on denial data in order to discover unpublished payer rules. We can customize the denial management software to recommend the relevant fixes for each denied claim. A rule engine can help implement the right billing processes to reduce the denials rate and increase revenue flow.

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The potentially high cost of appeals emphasizes the value of implementing an effective denial management process. An organization’s clean claim rate is one of the highest priorities. Clean claim rate (CCR) is defined as the ratio of passed claims that pass edits cleanly. The cleans claims do not require any correction or manual work prior sending it to the payers.

Our denial management in medical billing helps to simplify the transactional complexities between providers and payers by creating a seamless process of error-free claim submission. Though our custom denial management services, we focus on increasing the CCR through the revenue cycle to the point of claim creation, data collection has been correct and efficient. The solution can be tailored to provide timely claim alerts to notify them being flagged by the rule engine.

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In-depth analysis of root cause of the claim denials is highly crucial for denial management in US healthcare. As per the HIMSS analytics survey of 2016, more than 50% of hospitals do not leverage denial management analytics, eventually failing to reduce the denial ratio. The analysis helps to understand the standard triggers which cause claims denials instantly and the current faulty system can be optimized for better results.

We help the provider to understand the denial data and make it meaningful for the users with real-time analytics and easy-to-understand dashboards. Denial management medical billing can be made effective by visualizing the highly common denial trends. Healthcare denial management can be focused on these trends to create a smart action plan with alert parameters. The dashboard provides valuable performance metrics like initial denial rate, the rate of appeals, and win/loss ratio to streamline healthcare denial management in RCM.

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Automated claims management system or medical clearinghouse solutions are the most important part of denial management solutions. Before submitting the electronic claims to the payers, the in-house medical clearinghouse solution scrubs the claims for any missing data to validate the claims against payer-specific rules. Providing all users with a single, on-demand solution for managing every aspect of claims denial, from receipt to resubmission is the highest need of the hour.

OSP’ advanced claims management solutions thoroughly scrub the claims and flag those require review. This help to resolve the issues and errors before submitting the claims. A detailed claims processing report offers a complete list of errors and causes of rejections which are needed to be resolved for claim submission. Healthcare denial management systems can be customized for payer-specific rules to optimize the efforts of claims processing.

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As per the Advisory Board’s survey, the provider claims denial appeal is not a successful venture. The success rate for such appeals has dropped from 56% to 45% for private health plans. Denials for the patient in the emergency department are easy to appeal but managing the appeals successfully for a person being treated for a longer period of time is a cumbersome task.

OSP can replace the manual process of appeals and grievance management (A&G) by streamlining the complete process through automated denial management in US healthcare. A smart interface can help you to manage a seamless workflow for effective denial management in medical coding.  Automating the ongoing manual appeals management process can help providers to reduce stress, time and money needed to invest to get reimbursed for their authentic medical claims.

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