The problems plaguing today’s healthcare industry require more than off-the-shelf quick fixes or a technological silver bullet. These issues often require a unique prescription of business strategies that focus on financial performance, operations improvement, technology deployment, ongoing support and education, and resource allocation. ACS’ experienced professionals possess a thorough understanding of healthcare needs and issues, as well as in-depth knowledge of software vendor products. Physicians, registered nurses, medical technologists, registered pharmacists, business office managers, lab managers, and other credentialed professionals and financial and information technology experts comprise our experienced healthcare team that can help your organization achieve improved performance, and, ultimately, enhanced care delivery.

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Healthcare Payer

Overview: Payer Financial ServicesOPEN | DOWNLOAD | EMAIL
Overview: Membership Billing and ReconciliationOPEN | DOWNLOAD | EMAIL
Overview: Pharmacy SolutionsOPEN | DOWNLOAD | EMAIL
Overview: Transaction ProcessingOPEN | DOWNLOAD | EMAIL
Case Study: Healthcare Payer Customer Care SolutionOPEN | DOWNLOAD | EMAIL
Case Study: End-to-End Healthcare Claims ProcessingOPEN | DOWNLOAD | EMAIL
White Paper: ACS Knowledge ManagementOPEN | DOWNLOAD | EMAIL

Healthcare plans are under continual pressure to reduce costs, streamline processes, address consumer demands, and create new products and wellness solutions—all without sacrificing quality of care to their members or placing additional administrative burdens on providers. ACS can help payers meet these challenges. ACS enables administrative efficiencies through our highly scalable and flexible transactional business solutions. Payers benefit from a more engaged consumer realized through ACS’ innovative contact services and call center solutions. ACS also provides cost-of-care efficiencies through our cost recovery and cost avoidance services  

The payer industry is a key vertical for ACS. We are laser focused on assisting our health plans with their transformations. However, we also understand the importance of advancing the industry eco-system as a whole. ACS is uniquely positioned to provide solutions that create value for the entire industry from transactional to cost avoidance solutions. We will continue to make strategic investments in this key vertical in pursuit of our eco-system strategy.

In all ACS Healthcare Payer lines of business we offer a consultative approach that assists our customers in achieving their short- and long-term goals. ACS’ flexible approach to delivery encompasses our global delivery model as well as our domestic payer service centers. ACS offers an open technology solution, one that can be based on our world class technology or leverage our client’s existing technical infrastructure. Additionally, we provide a consultative approach to the critical issues of utilization, prescribing patterns, prescriber and patient education, and disease management through our government based healthcare service offerings.

ACS’ Healthcare Payer Division has adopted Lean Six Sigma strategic quality goals to deliver measurable and continuous improvement for our clients. Lean Six Sigma is a business strategy and methodology for improving process performance by eliminating waste and reducing variation. Because Lean Six Sigma provides a systematic means to achieving higher quality by reducing defects, customer satisfaction and financial performance increase exponentially.

Details on our Healthcare Payer solutions are offered below.
 
Transactional
As the cost of healthcare escalates and the demand for new and innovative products rises, healthcare payers seek solutions that enable administrative efficiencies. Put quite simply, health plans are looking for increased quality at a lower price point. This in turn allows the plan to create savings which help offset the rising cost of care as well as create funding mechanisms for future investments. Our transactional business has a tremendous track record of doing just that. ACS can help your organization create solutions to increase data quality, auto adjudication rates, and improve turn around time—all of which will improve your bottom line. 

Our transactional business provides solutions for all operational towers including: claims, membership & billing, provider maintenance and eligibility. By combining our extensive domain knowledge, business rule engines, and world class operating model, ACS can provide your health plan with tangible results.

Service areas include:

  • EDI Clearinghouse
  • Mail Room Services
  • Data Capture/OCR Solutions
  • Claims Processing Solutions
  • Enrollment/Eligibility Solutions
  • Billing, Payment, & Reconciliation Solutions

Contact Services/Customer Care
The demand for consumer oriented products and information are creating opportunities for health plans to engage their stakeholders in new and innovative ways. Health plans are not only challenged to respond to requests concerning administrative items such as eligibility, claim status and benefit applications, but also the need to begin reaching out to consumers to help them navigate the new world of healthcare. Additionally, health plans are seeking customer care engagement models for prevention and wellness programs that require a deep understanding of the market as well as clinical and consultative expertise. Our contact centers bring all these disciplines together within one organization. 

The ACS payer organization provides results today with a forward thinking, flexible solution that will accommodate the demands of tomorrow.

Service areas include:

  • Member and Provider Inbound Services
  • Self-service Contact Solutions
  • Web, Chat and Email Response Solutions
  • IVR and CTI based Solutions
  • Advanced Switch/Multiple Platform Integration Solutions
  • Customer Relationship Management (CRM)
  • Workforce Management Services

Cost Recovery, Audit and Avoidance  
Enabling administrative efficiencies and engaging your stakeholders in new and meaningful ways are critical success factors for most health plans, however, managing the cost of care is the life blood of the organization. In our cost recovery and avoidance business we assist the payer market in avoiding and ultimately recovering dollars related to claim cost that has been or would have been inappropriately paid. ACS offers our customers end-to-end services in this very important market niche. Through our data mining and business rule engines we identify, track, and sometimes litigate on behalf of our customers to ensure their exposure is accurate. We also provide auditing solutions on behalf of the payer community. ACS is uniquely positioned to help our customers along the path from recovery to avoidance.

Service areas include:

  • Data Mining and Analysis
  • Subrogation
  • Coordination of Benefit
  • Overpayment Solutions
  • Hospital Credit Balance Audits
  • End Stage Renal Dialysis Analysis and Audits
  • Long Term Care Analysis and Audits
  • Pharmacy Benefit Management Analysis and Audits

ACS Healthcare Solutions (Healthcare Provider Services)

Case Study: Enhancing Financial Vital SignsOPEN | DOWNLOAD | EMAIL
Case Study: Extra Care for Care ManagementOPEN | DOWNLOAD | EMAIL
Case Study: Integrated Digitized SystemOPEN | DOWNLOAD | EMAIL

Healthcare providers are currently facing a number of challenges, including rising costs, lower reimbursements, staffing shortages, regulatory deadlines, threats to quality of care, and administrative inefficiencies. These obstacles rob revenue from core activities that should garner the attention of your staff. That’s where ACS comes in. Our understanding of the healthcare industry and the vendors who support providers of healthcare is unsurpassed. Our combined experience includes a keen understanding of healthcare information technology needs, clinical workflows and processes, administration and patient accounting, business office and revenue cycle operations as well as expertise with each vendor’s products, giving us the ability to provide reliable and client-specific hands-on assistance and consultative advisory services to all types of healthcare organizations.

Consulting Services
Today’s end-user of clinical technology is generally more experienced and self-reliant than in the past, often implementing and operating a variety of vendor’s products on their own. As a result, ACS is often called in for consulting services that go beyond basic solution installment—encompassing a combination of project management, operations improvement, backfill services, staff augmentation, and clinical lead experience. We help our clients plan, design, implement and integrate information technology and business process solutions that help them generate reliable data and streamline operations. Our experience includes implementing all major healthcare vendor systems including: Cerner, Eclipsys, Epic, GE Healthcare, MEDITECH, Siemens, McKesson, Lawson, and Kronos.

Drawing on the breadth of our knowledge, experience, and talent, ACS Healthcare Solutions implements clinical, business, and technology solutions that help healthcare organizations meet the industry's top challenges. With our multi-faceted approach, our clients are able to achieve improved quality, reduced operating costs, increased staff productivity, and improved patient/physician/staff satisfaction. 

Service areas include:

  • Performance Improvement and Strategy
  • Clinical Transformation and Readiness Assessments
  • Hospital Enterprise-Wide 360 Assessment
  • IT Strategy and Planning
  • IT Systems Selection and Contract Negotiation
  • Implementation, Interim Staffing, and Training
  • IT Security and Systems Integration
  • Systems Optimization and Workflow Redesign
  • Supply Chain Management

Transformational Outsourcing
Healthcare providers are continually faced with both rising costs to provide quality healthcare and revenue limitations from payers. These opposing forces are requiring healthcare providers to re-evaluate how they can improve the quality of patient care while also improving overall efficiency. More and more, healthcare providers are turning to technology to meet these challenges—resulting in a reliance on digital information and communication that may exceed an organization’s internal capabilities or capacity. ACS has the knowledge and expertise to help your enterprise obtain, implement, and manage a full range of services and solutions that can ideally meet your organization’s specific needs, objectives, culture, and strategic focus.

Service areas include:

  • Application Management
  • Interim IT Management
  • Infrastructure Outsourcing
  • 24/7 Remote Network Monitoring
  • Help Desk Support (NetLinc)
  • Full-service IT Outsourcing

Revenue Cycle Management
The billing and collection cycle for healthcare organizations is costly, fragmented, and labor-intensive. Couple this with disjointed information systems and redundant, inefficient manual processes, and the result is uncollected patient bills/insurance reimbursements, aged accounts, bad debts, and massive write-off. Additionally, there is often money left on the table from an out-of-date Charge Description Master, lack of medical records coding audits, and weak physician documentation.

ACS provides a full array of financial performance improvement services and more than 60 years of revenue cycle management knowledge and experience, with top professionals that have successfully managed the revenue cycle in various institutions nationwide. ACS has a track record of providing comprehensive, proven solutions to the healthcare industry and knows intimately the full range of vendor products. Our integrated solutions are focused on accurately evaluating your revenue cycle performance in relation to best practices, and proposing the most appropriate course of action to improve performance. We help our clients enhance processes with enabling tools and training so that they can achieve—and sustain—significant revenue cycle performance and cash improvements.

Service areas include:

  • Revenue Cycle Performance Evaluation
  • Charge Description Master (CDM) Review
  • Medical Records Coding Audit and Education
  • Denial Management
  • A/R Recovery
  • Business Process Redesign
  • Information Technology Planning, Selection and Implementation
  • Revenue Cycle Outsourcing

Analytic Solutions
Through our Analytic Solutions group—a market-leader in medical information management technology—we provide a full suite of software solutions and management/measurement tools associated with care management, clinical decision support, and provider information management functions.

The MIDAS+ integrated suite of solutions includes:

  • MIDAS+ Care Management - integrates discipline-specific modules in the Case, Quality, and Rick Management subsystems
  • MIDAS+ SmartConnect - automates discharge placement workflow and electronically connects all constituents in the care continuum
  • MIDAS+ DataVision - a suite of data analysis and benchmarking tools comparing over 3,000 performance measures in the MIDAS+ national comparative database.
  • MIDAS+ Seeker - a comprehensive medical staff management solution including online appointment/privileging and Web querying.
  • MIDAS+ Bed Ready - a full-featured capacity management and patient throughput solution for bed management, housekeeping and transport.
  • MIDAS+ JRepository - a comprehensive communication, collaboration and workflow solution that addresses continuous accreditation readiness.

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