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ZirMed Claims and A/R Management Solutions
ZirMed Claims and
A/R Management Solutions
®
S
erving nearly 300,000 providers and over
8,000 healthcare organizations across the
nation, ZirMed’s complete collection of cloud-
Gain faster, easier, more
powerful claims and
accounts receivable
workflows.
based Claims and A/R Management solutions
helps you maximize revenue and productivity
while reducing A/R days and write-offs. They’re
always up-to-date with changing government
regulations, payer policies, and patient payment models. And they all provide powerful,
easy-to-use web-based interfaces for higher
productivity and faster training:
• Benefit from hyper-efficient claims and
A/R workflows
• Manage claims with maximum efficiency
• Reduce preventable denials with ZirMed’s
98%+ first-pass clean claims rate
• Gain insight into your financial performance
and make better informed decisions
• Recover underpayments
• Manage contracts
Hyper-efficient Claims and A/R Workflows—ZirMed’s
Claims and A/R Management solutions are a key aspect
of the nation’s only comprehensive end-to-end platform
of cloud-based financial and clinical performance
management solutions.
Coding Tools
Digital Lockbox
With ZirMed Coding Tools, you can equip
Designed specifically to reduce the time,
your team with the solutions they need to
effort, and errors associated with paper
easily search for and find the codes they
check payments from payers, ZirMed Digital
need, and your organization will benefit from
Lockbox saves you time and money at
an extra layer of assurance that coding is
every step—from receiving, opening, and
complete and correct—before claims are
processing paper checks to posting and
submitted. Choose from a full line of basic
reconciling payments.
and enhanced coding tools for ICD-9 and
• Takes digital images and indexes all
ICD-10 coding, CPT/HCPCS and CPT/
HCPS coding, and much more.
Remits
Claims Management
Forget the time-consuming process of
manually posting payments that leads to
checks and documents.
• Electronically deposits payments
into your accounts in less than two
business days.
• Converts paper remittance advices into
ZirMed’s Claims Management solution
costly delays and unrealized revenue. With
helps you close the payment efficiency gap
ZirMed’s Remits solution, you can receive
quickly and cost-effectively. With one of the
all your remits electronically–from all payers
most extensive real-time claims submission
and in one system. Just send us your recent
solutions in the industry, ZirMed offers elec-
remits files, and our dedicated enrollment
Denial & Appeal Management
tronic connections to virtually all payers. We
team will facilitate enrollment with your payers.
90% of denials are preventable and 67%
• Receive all remits from payers in the
are recoverable. ZirMed’s Denial & Appeal
support both Professional and Institutional
claims, and can accept submissions in any
format—from ANSI X12 837 and all versions
of the National Standard Format to proprietary data protocols and even print files.
• Less Work—no more lost claims!
• Simplicity—handles both primary
and secondary claims through a single
online solution.
• Speed—scrubs and executes all claims,
including batch submissions, in real time.
• Control—see every step on a single
easy-to-use online dashboard.
• Insight—our innovative analytics help you
understand why claims get rejected.
• Easy-to-create workgroups—with the
standard 835 electronic format.
• Work paper remits electronically
with automatic conversion to the
835 format (requires EOB Conversion
with Payer Lockbox).
• Search by date, payment number,
patient, ICN, patient number, and other
advanced search options.
• Choose from ZirMed’s flexible build
options to match your workflow and
PM system requirements.
electronic transactions.
• Automatically reconciles claims, deposits,
and remittances for payer payments.
Management solution provides a streamlined, results-focused workflow for managing denials—and delivers the insights you
need to make sustainable reductions in your
overall denial rate. Features include:
• Management and Reporting—clear
reporting on reworked claims and results,
including write-offs and special cases.
• Workflow Automation—automatic,
accurate routing of denials to the
appropriate individual or team.
• Appeal Packages—the only 100%
paperless comprehensive appeal packages, printed and mailed on your behalf.
• Integrates With Every PM System—
ZirMed Workcenter, your staff sees only
delivers notes and documentation of all
the claims you want them to work.
activity back to your system daily.
ZirMed Claims and A/R Management Solutions
Denial Management
for Hospitals
Self-Pay Management
A/R Management
ZirMed Self-Pay Management uses power-
ZirMed’s A/R Management solution delivers
Gain a comprehensive platform for back-
ful algorithms to analyze thousands of
advanced workflow and analytics to focus
end revenue cycle and front-end patient
patient attributes and accurately assess
your staff on the right accounts at the right
access administrators to more effectively
whether a patient’s propensity to pay is low,
time to maximize hospital yields. ZirMed’s
and efficiently follow-up on denials—while
medium, or high—enabling you to tailor
data mining algorithms minimize lost
arming hospital financial executives with
your collection strategies accordingly. The
revenue due to processing inefficiencies
the workflow and analytics to put them on
customizable dashboard offers a quick
by centralizing disparate data sources—
equal footing with payers.
way to see true self-pay admissions, true
and processing all accounts, claims, and
• Provides a comprehensive view
self-pay revenue by groupings, patient
transactions—to identify new revenue
across your health system as well as
A/R summary, upfront collections, patient
opportunities, accelerate cash flow, and
each facility.
payments, and probability to pay.
continuously isolate at-risk accounts.
• Parses payer claim remittance data to
accurately identify each denial.
• Uses predictive analytics to identify
claims that are likely to be denied and
can be successfully appealed.
• Provides scorecards to benchmark all
payers by all denials.
• Measures follow-up effectiveness on
denial appeal and collection rates.
• Provides reporting intelligence to
improve the source of denial issues.
• Offers custom reporting (i.e. report
builder) and ad hoc analysis.
• Maximize collection yield
• Reduce collection expense
• Increase POS collections
• Reduce bad debt write-offs
• Optimize charity
• Optimize vendor allocation
• Target insurance conversions
ZirMed Claims and A/R Management Solutions
• Key Performance Indicators—maintain
A/R Intelligence
Revenue Cycle Analytics
How many overdue accounts in your A/R
Today’s most successful practices increas-
ledger simply result from not being aware
ingly use metrics to constantly monitor their
of a patient’s insurance coverage—or not
performance so they can act decisively to
knowing that a Medicaid application filed at
address issues before they significantly
build their own dashboard based on what
the time of service was confirmed, because
impact their organizations. ZirMed’s
they need to know, then see the “big
the notification was sent to the patient and
Revenue Cycle Analytics solution works
picture” or drill down into the details.
not to you? ZirMed A/R Intelligence analyzes
across your PM and EHR systems—even
your accounts receivables for overlooked
if you use multiple ones—to provide
color-coded KPIs and reports provide
patient insurance coverage—then tells you
insight into your operational and financial
clear insight and guidance.
the information you need to file the patient’s
performance and help you make smarter,
claim with the carrier.
better-informed decisions.
organizational goals with ZirMed’s easyto-customize gallery of KPIs.
• Custom Dashboards—each user can
• Actionable Information—easy-to-read,
Ready for faster, easier, more powerful claims and A/R workflows? Contact ZirMed at Contact ZirMed
at 877-494-1032 or request a personalized demo at public.zirmed.com/claims-ar.
About ZirMed®
ZirMed empowers healthcare organizations of all sizes and types to optimize revenue and population health with the nation’s only comprehensive end-to-end
platform of cloud-based financial and clinical performance management solutions—including claims and A/R management, charge integrity, patient access
and engagement, population risk management, and cost and utilization. By combining breakthrough predictive analytics technology with innovative software
development and the industry’s most advanced transactional network, ZirMed solutions extract actionable insights that improve our clients’ revenue cycles
and support effective population health management—while streamlining workflows, increasing operating efficiencies, and driving bottom-line performance.
ZirMed’s technology and client support continue to be honored with top industry awards, including KLAS®, Healthcare Informatics, Best of SaaS Showplace
(BoSS), and Black Book Rankings. To learn how ZirMed can help your healthcare organization boost its financial and clinical performance in an era of changing
reimbursement models and rising operating costs, visit www.ZirMed.com.
© 2015 ZirMed, Inc. All rights reserved.