Revenue Cycle Management

AusHealth’s suite of Revenue Cycle Management Services can relieve all the pain points in your revenue lifecycle, including patient financial clearance, patient financial care, billing and invoicing, insurance claims and debt recovery.

Our Australia-wide clients range from inner-city hospital networks to diagnostic centres, from allied health professionals to ambulance services.

Our Revenue Cycle Management Services include:   

Patient Financial Clearance Services: Services to help you understand a patient’s propensity to pay and avoid bad debts.

Patient Admissions & Financial Care Services: Smooth the process of patient admission AND reduce time to payment

Insurance Claims Management: Are your revenues locked up by the process of managing claims? Leave it to our highly trained teams to review, submit and manage your claims

Aged Care Patients: AusHealth has a revenue management solution to support your aged care patients

Medical Repatriation Services: It’s costly and complex. So how about we take care of it for you?

Revenue Cycle Management Review Services: We’ll provide a health check on your organisation’s current revenue lifecycle – and help map out a strategy for future success

BPO (Business Process Outsourcing) Solutions: Bring AusHealth’s 40 years of experience into your organisation… Our BPO Solutions can be scaled for your front-office and back-office needs

We’ll help you anticipate a patient’s propensity to pay – improving reimbursements and saving you the costs of bad debts.

Operating onsite or offsite, our providers of Patient Financial Clearance Services use the latest technology and predictive analytics to safeguard against patients becoming debtors.

Checks include:

• Medicare eligibility
• Insurance coverage
• Financial hardship assessments
• Vulnerability assessments
• Patient propensity to pay
• Guarantor availability and strength
• Medical loans

If the services are provided onsite, AusHealth will work alongside your staff to perform all the above checks in a secure manner and in compliance with privacy and NSQHS standards.

If a solution is implemented offsite, our virtual Patient Liaison Team will be able to guide and help your staff with rich, accurate, real-time clearance information.

Bottom-line benefits:

• Increase reimbursements
• Accelerate collections
• Slash denials
• Lift staff productivity

Related solutions:

• Patient Admissions & Financial Care

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au

Harness the power of AusHealth’s single patient liaison platform – a suite of onsite and offsite services that will ensure your admissions are financially sound. You’ll reduce time to payment and enjoy revenue recovery rates of up to 90%.

There are two services available, tailored to:

• Medicare & Non-Medicare Patients
• Long Stay Patients & Nursing Home-type Patients 

Medicare & Non-Medicare Patients

Our highly trained AusHealth staff include onsite and offsite Patient Liaison Officers. They use experience, skills and resources to manage the revenue lifecycle of an admission for eligible and non-eligible Medicare patients.

As part of your solution, they will take responsibility for a raft of processes, including:

• Admission administration
• Financial consent completion and charge capture
• Real-time eligibility and coverage checks
• Advanced ‘patient propensity to pay’ analysis
• Early medical repatriation identification
• Pricing analysis
• Billing and invoicing
• Third-party funder clearing
• Risk-based credit management
• Hardship assessments
• Negotiating and taking payments
• Payment plans
• Settlements
• Guarantor arrangements
• Reporting (internal and external)
• Client portal

Bottom-line benefits:

• Improve your average rate of revenue recovery to as high as 90%
• Reduce your insurance payment wait times – in some instances from one year down to just 60 days
• Improve your cash returns by more than 30%
• Significantly reduce your aged debt and doubtful debt provisions
• Reduce your regulatory risk (including Privacy, Confidentiality and ACCC) to less than 5% probability of an adverse event; and save approximately $350,000pa in legal costs
• Reduce your operating costs by more than 2FTE, amounting to $195,000pa
• Increase your PCIS compliance to 100%

Related solutions:

• Patient Financial Clearance
• Insurance Management
• Debt Collection
• Medical Repatriation 

Long-stay Patients & Nursing Home-type Patients

Long-stay patients and nursing home-type patients can end up staying in hospital for weeks, months or even years. As well as affecting the patient, this situation can have a profound impact on the hospital’s staff, resources and finances.

Leave it to AusHealth to manage this often complex situation with a special long-stay and nursing home-type solution.

It provides:

• Onsite/on-call Patient Liaison Officers
• Informed financial consenting (and re-consenting)
• Fee transparency discussions
• Assistance payments
• Patient notification
• Contribution agreements
• Authorised representative/carer discussions
• Invoicing and billing
• Debt collection

We integrate with your hospital’s patient care team and Quality Care Plans to ensure a respectful and collaborative approach.

Bottom-line benefits:

• Improve your average resolution rate to 55% and as high as 75%
• Improve your cash returns by more than 30%
• Significantly reduce your aged debt and doubtful debt provisions

Related solutions:

• Patient Admissions & Financial Care
• Debt Collection

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au

Managing claims to insurers can be one of the most demanding parts of the revenue cycle. Leave it to our skilled teams to review, submit and manage your claims.

AusHealth’s Insurance Management Solutions offer a suite of services to help smooth out your workflow and unlock revenue.

Our teams have experience working with all types of insurers, including health insurers, international insurers, travel insurers, work insurers and disability insurers.

AusHealth’s first-pass clean claims rate is more than 85%.

We provide three services:

• Insurance Management
• Insurance Claim & Payment Review
• Insurance Denial Management

Insurance Management services

Our Insurance Management clearing solution offers a suite of services including:

• Pre-claim eligibility
• Coverage detection
• Strong funder relationships
• Enriched submissions
• Claim follow-up control
• Online claim status
• Denial management
• Reporting and analytics

Bottom-line benefits:

• First-pass clean claims rate is more than 85%
• Reduced denials by up to 40% for some clients

Related solutions:

• Patient Admissions & Financial Care

Insurance Claim & Payment Review

We’ll carry out a detailed review of your current workflows – from patient registration to claims submission – to discover the root causes behind your claim pain points.

Then, we’ll help you implement best practices and re-engineer workflows.

As part of this solution, we’ll also review your transactions with insurers to ensure the maximum was claimed and paid.

We’ll review a number of your processes, including your:

• Pre-claim eligibility authorisation processes
• Coverage detection processes
• Submission effectiveness
• Documentation
• Missing and invalid claim data
• Denial management

Our continued monitoring will help keep things moving in the right direction, ensuring the root causes of pain points have been resolved while fine-tuning workflow modifications using trend reporting and data analytics.

Bottom-line benefits:

• Increase reimbursement and cash flow

Related solutions:

• Insurance Management

Insurance Claim Denial Management

We’ll manage your denials promptly and precisely to help you collect more revenue, faster.

You can trust AusHealth’s trained staff to convert your denials: they enjoy a success rate greater than 40%.

AusHealth’s Claim Denial Management Solution uses our deep revenue lifecycle expertise and funder relationships to simplify the management and prioritisation of denied claims.

Bottom-line benefits:

• Increase reimbursement and cash flow
• Decrease labour costs
• Successful conversion rate is greater than 40%.

Related solutions:

• Insurance Management

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au

Aged Care facilities operating on small margins need to constantly manage their enterprise value and look for opportunities to maximise revenues and manage risk. AusHealth offers a suite of services to relieve these pain points.

Despite funding reforms in 2022, many aged-care facilities face a challenging financial position. On one hand there’s a high demand for their services; on the other, they face rising operating costs which continue to impact residential facilities.

Aged care recipients as well as their carers are also experiencing greater difficulty paying their bills, especially with Australia’s rising cost of living. Those paying a daily fee, care fee or accommodation costs can find themselves in a particularly difficult position.

It’s essential that aged care providers manage these contributions effectively in order to maintain financial stability.

AusHealth offers a suite of services for aged care services. Our services include:

• Propensity-to-pay assessments
• Risk-based credit management
• Authorised representative/carer discussions
• Invoicing and billing
• Debt collection
• Negotiating and managing payment plans
• Taking payments

Related Solutions:

• Financial Clearance
• Debt Collection
• Revenue Cycle Management Review

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 0401 123 060

Email: ctomkins@aushealth.com.au

Hospitals are increasingly having to deal with the costly and often complex business of medical repatriation. AusHealth provides an extensive suite of services to help with arranging aeromedical transport, cost subsidisation assessment and working with clinical staff in respect of discharge planning.

As the number of post-Covid visitors to Australia continues to rise, AusHealth has noted a commensurate rise in repatriation discussions among hospitals.

Repatriating patients comes with a raft of complex decisions arising from an interplay of overlapping domains (clinical, hospital, legal, immigration, medical ethics, cultural etc). Concerns are also increasingly being raised regarding:

• Being unable to receive reimbursement for the care of Medicare-ineligible visitors
• Balancing legal duties to treat all patients with emergent health needs
• Discharging patients to appropriate facilities for further care

AusHealth’s Medical Repatriation Solutions can assist hospitals with:

• Domestic or international aeromedical transport
• Insurance administration and repatriation costs
• Cost subsidisation assessment
• Working with clinical staff in respect of discharge planning
• Due diligence covering an assessment of the patient’s home situation or healthcare facility, caregiver support, and access to necessary follow-up care
• Organising professional and qualified staff including specialist flight clinicians and registered flight nurses who work in the critical care field
• Repatriation equipment
• Government clearances and home travel
• Informed consent

Related solutions:

• Patient admissions and financial care 

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au

Get a clear picture of your organisation’s financial performance and a roadmap for future success.

AusHealth has three solutions to help you identify shortcomings in your revenue management processes:

• Revenue Cycle Management (RCM) Review
• Debt Collections Process & Portfolio Analysis
• Compliance Audit & Insights

Revenue Cycle Management (RCM) Review

AusHealth’s Revenue Cycle Management (RCM) Review is a strategic tool for gathering valuable information, uncovering hidden problems and revealing unseen threats to your bottom line. It’s also the means to set focused goals that align with your organisation’s objectives.

As an RCM review provider, AusHealth can be pivotal in transforming insights into actionable strategies that propel growth.

Our RCM review will incorporate the following services:

• Patient Registration & Financial Clearance
• Patient Admissions & Financial Care
• Insurance Management
• Clinical Coding
• Debt Collection

Debt Collections Process & Portfolio Analysis

AusHealth will undertake a comprehensive process and portfolio evaluation, including a detailed analysis of risk, potential returns and diversification options.

The evaluation seeks to identify, quantify and explain the sources – and contributions – of risk and return in a portfolio.

Our portfolio analysis platform is powered by a suite of services as well as proprietary and institutional-grade intellectual property.

For clients with more complex requirements, we offer a range of custom analytics including portfolio stress testing as well as a full-service consulting program.

Compliance Audit & Insights

At AusHealth, we understand the complexities of privacy, confidentiality and PCI compliance. When it comes to debt collection and Insurer Management, we strictly adhere to the ACCC/ASIC Debt Collection Guidelines.

Our Statutory Compliance Audit services provide a comprehensive audit of all our clients’ labour-related records, status determination, criticality analysis and expert consultation with solution-based presentations.

This ensures clients meet all necessary compliance requirements, minimizing risk exposure and liability.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au

Unleash the value of Business Process Outsourcing (BPO) and Knowledge Process Outsourcing (KPO) through our scalable front and back-office solutions. Whether you’re looking for patient financial care, clinical coding, insurance management or debt collection, we have the team to help you.

Aushealth offers a suite of BPO solutions:

• Patient Financial Care (Patient Liaison) BPO
• Debt Recovery & Insurance Management BPO
• Clinical Coding & Auditing BPO
• Staffing Solutions

Patient Financial Care (Patient Liaison) BPO

Effective patient financial care at – or after – presentation helps hospitals and other healthcare providers manage and optimise their revenue lifecycle and maintain brand reputation.

AusHealth’s BPO/KPO teams are among the best in Australia and fit seamlessly into a hospital or healthcare provider’s operations. Regular upskilling and knowledge-sharing are part of AusHealth’s commitment to excellence, ensuring that workers remain agile and informed.

AusHealth offers full-time and part-time, casual or needs-based outsourcing of its patient liaison staff. Our use of advanced technologies, data analytics and automated systems means a patient’s financials are taken care of efficiently and effectively.

Find out about our Patient Admissions & Financial Care solution.

Debt Collection & Insurance Management BPO

Debt collection and insurance management can be one of the most demanding and time-consuming parts of the revenue cycle.

AusHealth’s Debt Collection & Insurance Management BPO is a back-office solution. It can conveniently and securely review, submit and manage your claims, and recover your outstanding debt.

Our approach extends beyond cost-saving: we bring experience, a commitment to quality, and innovation in debt collection and insurance management.

When it comes to managing insurance, we provide flexibility, access to advanced technologies and the benefits of long-standing relationships.

AusHealth’s solutions can be accessed on a full-time or needs-based arrangement.

Clinical Coding & Analytical Auditing BPO

Our clinical coders and health information managers are certified, experienced and knowledgeable. They support hospitals on a permanent, long-term or short-term basis; services can be provided remotely or on-site depending on a client’s needs.

Find out more about our Clinical Coding solutions, and here for our Analytical Auditing solutions.

 Staffing Solutions

AusHealth understands that finding the right talent for short-term, project or long-term staffing gaps can be a challenge. That’s why we offer comprehensive on-site and remote staffing solutions for:

• Patient financial care
• Clinical coders
• Health information managers
• Accounts receivable specialists
• Insurance specialists

Our flexible solutions ensure that you have access to skilled professionals who can work onsite or remotely, based on your specific requirements.

Bottom-line benefits of BPO/KPO:

• Improve your recovery rate to 85% and as high as 90%
• Reduce your insurance payment wait times – in some instances from one year down to just 60 days
• Improve your cash returns by more than 30%
• Significantly reduce your aged debt and doubtful debt provisions
• Reduce your regulatory risk (including Privacy, Confidentiality and ACCC) to less than 5% probability of an adverse event; and save approximately $350,000pa in legal costs
• Reduce your operating costs by more than 2FTE – amounting to $195,000pa
• Increase your PCIS compliance to 100%
• Reduce your default rates to less than 2% (subject to hardship assessments)

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: customerservice@aushealth.com.au