Collaboratives

The Challenge

Revenue Leakage and Inefficiencies

Traditional billing processes, out-of-network reimbursements, and complex claims create bottlenecks that delay payments, increase denials, and erode revenue. HealthWorks understands that revenue cycle inefficiencies stem from fragmented processes, payer misalignment, and outdated billing methodologies.

• Traditional Billing:
Claims inconsistencies and lack of real-time monitoring lead to avoidable denials.

• Out-of-Network Billing:
IDR complexities and payer negotiations make reimbursement unpredictable.

• Complex Claims:
High-dollar cases require specialized expertise to prevent underpayments and revenue loss.

The Solution

Proactive Precision in Revenue Management

HealthWorks embeds rule-driven logic, real-time validation, and behavior-responsive engagement to optimize revenue at the source—reducing denials, improving collections, and reinforcing trust.

• Claims Readiness:
Ensures every claim is accurate, complete, and payer-aligned before submission.

• Frontline Alignment:
Connects coding, compliance, and patient engagement in one structured workflow.

• Revenue Assurance:
Prevents leakage by surfacing gaps, validating documentation, and supporting defensible billing.

The Results

The Challenge

Coding Variability That Drives Denials and Risk

Manual workflows, subjective interpretation, and fragmented documentation create a coding environment prone to error. As regulatory demands and payer rules grow more complex, even experienced teams face rising denials, audit exposure, and missed revenue.

• Workforce Variability:
High turnover, and uneven experience levels (especially with offshore operations) lead to variable coding accuracy and missed details on complex cases.

• Documentation Disconnects:
Misalignment between documentation and coding logic drives DRG errors and audit risk.

• Regulatory Complexity:
Frequent coding updates and shifting payer policies strain manual processes.

The Solution

Structured Intelligence for Coding Accuracy and DRG Integrity

HealthWorks applies rules-based automation, embedded logic, and integrated DRG validation to ensure coding precision across inpatient and outpatient encounters—before the claim is submitted.

• Technology-Enriched Coding Review:
Auto-applies embedded logic and real-time validation to surface documentation gaps and prevent errors before submission.

• Scalable Coding Expertise:
Equips coders with embedded logic, structured guidance, and intelligent workflows to drive accuracy, completeness, and efficiency at scale.

• DRG Audit and Assurance:
Validates diagnosis and procedure alignment to protect against missed revenue and preventable downgrades.

The Results

The Challenge

Patient Confusion, Payment Delays, and Collection Risk

Patients are overwhelmed by fragmented billing experiences—unclear balances, disjointed communications, and payment workflows that lack personalization–leading to slower collections, increased bad debt, and frustration that erodes trust and loyalty.

• Limited Transparency:
Patients lack clarity on what they owe, why they owe it, and how to resolve it.

• Disjointed Billing Experience:
Inconsistent communication and rigid payment options hinder patient action.

• Eroded Trust:
Financial confusion undermines satisfaction, loyalty, and timely payment behavior.

The Solution

Patient-Centric Billing and Communication

HealthWorks simplifies the billing experience through clear communication, personalized engagement, and automated payment pathways—helping patients understand what they owe and act with confidence.

• Behavior-Driven Billing Communication:
Outreach is timed, tailored, and tested to improve clarity and drive action.

• Flexible, Frictionless Payment Options:
Self-service tools, payment optionality, and reminders meet patients where they are.

• Responsive Engagement Engine:
Real-time logic adapts messaging and channel mix based on patient behavior and account status.

The Results

The Challenge

Preventable Denials and Avoidable Waste

High denial volumes drain time, staff, and revenue—most stemming from issues that could have been addressed upstream. Without real-time insight and documentation alignment, denials remain a persistent source of rework and lost reimbursement.

• Coding Gaps:
Minor documentation or code errors trigger avoidable denials.

• Outdated Policy Awareness:
Missed payer rule changes result in preventable rejections.

• Weak Appeal Foundations:
Incomplete evidence and slow responses reduce recovery success.

The Solution

Embedded Denial Prevention and Submission Confidence

HealthWorks transforms denial prevention from a reactive back-end task into an integrated front-end safeguard. By validating documentation, verifying coding accuracy, and simulating common denial triggers before claims are submitted, we ensure each claim is structured for success—reducing rework and accelerating payment.

• Integrated Edit Simulation:
Applies automated checks to catch and correct issues before claims go out.

• Pre-Submission Validation:
Ensures each claim is supported by appropriate documentation and coding logic.

• Appeal-Ready Files:
Connects each code to clear rationale and evidence for fast, confident resolution if a denial occurs.

The Results