The New Language of RCM: Denial Prevention and Perimeter Defense

Wave HDC is a healthcare data curation company committed to curating data at the point of registration and scheduling that optimizes the revenue cycle management process, lurking in the shadows, and preventing denials. We focus on eligibility, but not the eligibility you’re thinking of. Sure, we can verify the coverage on file, but you are an expert at your craft, and you know that’s not really the process you’re seeking, but that’s all that’s been available. What if you could not only verify coverage on file, in real-time, but correct COB with accurate primacy determination, replace the inaccurate coverage on file, and resolve demographic issues, all in real-time when and where it has the most impact? The answer is you would reduce your denial volume by 35% or more, and there would be no proof of work, just trailing indicators from technology doing its job, lurking in the shadows. By injecting these corrections early in the revenue cycle process, we help clients, and their patients avoid and resolve issues that would normally be resolved later in the revenue cycle, avoiding rework, AR delay, and the rising contingency fees you’re likely paying.

The heart of our differentiation is the term Denial Prevention; our solution is positioned as a point-of-scheduling/registration optimization suite that injects corrections as patient registration occurs. When most vendors perform standard eligibility verification, you know, the process that hasn’t changed in about 25 years, Wave provides a means to identify and correct missing primary or an undocumented secondary, do real-time insurance discovery on a self-pay, identify charity care or failed verification, and correct a wide range of other errors that cost providers millions each year. How much does your organization spend on early out, collections, and contingency fee discovery vendors? Most of this is avoidable, with zero, ZERO resources. In fact, you can reallocate some resources, because the teams who fix the bad data will come in one shift to find their queues are anemic, but it’s not a mistake; it’s modernization.

By focusing on early intervention and correction, our client partners avoid delays in the revenue cycle that typically drive up denial rates and increase costs. This is the concept behind Perimeter Defense, a very important concept (and practice for some) in today’s business climate. FTE costs and the difficulty in finding and keeping talented staff have become a top concern for revenue cycle and hospital leadership. Equally important are the runaway contingency costs that early out, collections, and discovery vendors are charging to simply correct issues that, for the most part, could have and should have been identified and resolved at pre-service or with the patient present.

We define Perimeter Defense and Denial Prevention as the early identification of problems at the point when a patient is first presented into the healthcare system, such as scheduling or registration desk in the ER. Perimeter Defense goes into action by identifying billing issues via the eligibility workflow that typically go undiagnosed until a denial occurs. Instead, Wave HDC seamlessly identifies COB and coverage issues as well as demographic and identity issues and corrects them in real-time with low-touch and even no-touch automation. This systematic approach to curating healthcare data and correcting patient records at the entry point of healthcare accelerate the revenue cycle process and avoids lost revenues and mounting costs of delayed, human-intensive post-claim remediation and timely filing issues.

If your current vendor partners are not focused on Denial Prevention and Perimeter Defense, you’re not alone. Traditional off-the-shelf patient access and RCM solutions are hyper-focused on 1) commoditized transaction services that simply verify what you know or 2) contingency fee services models that are incentivized to not solve the underlying problem, but rather extract continuous revenue from you to treat the symptoms. Much of the RCM technology industry is incentivized to maintain the status quo while operating with a facade of innovation. Apologies to our peers for speaking the truth, the obvious, and the fixable.

It is time to finally solve problems before they occur, at the front end, and avoid the ever-increasing costs of remediation while providing your patients and team members with a better overall experience. Wave doesn’t think or work like legacy technology partners. Instead, Wave has been focused on designing, building, and deploying solutions that focus on automated remediation and correction at the point of entry into your healthcare RCM workflow. Expect modern solutions focused on Denial Prevention.

It's time to demand more from your technology partners and spend less on total operating costs.