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Trilogi® Revenue Recovery
Trilogi® from Recondo is a collaborative of clinical, legal, and financial recovery experts, educators, and advocates. Our solutions resolve slow pay, no pay, and denied claims — reducing accounts receivable, improving case management efficiency, and maximizing payer collections quickly and accurately. We are a leader in revenue recovery and Business Process Outsourcing.
Clinical
Decisions made by case managers and hospital staff, while patients are in the hospital, often result in contested or non-reimbursable charges. Our highly experienced clinicians provide value-added insight to educate case managers and staff about common pitfalls, and how to implement best practices and procedures to optimize the revenue cycle. Our team helps you reduce delayed or denied payments due to:
- Medical Necessity
- Length of stay
- No authorization
- No pre-certification
- Level of care issues
- Delay in treatment
- Inpatient vs. outpatient
Legal
Our attorneys specialize in state and federal regulations related to healthcare and insurance. The insurance companies have teams of attorneys guiding them through the complex regulatory maze. We serve as advocates for you and the patient, leveling the playing field with your payers. Trilogi attorneys understand compliance issues related to payer legal obligations and restrictions. In addition to understanding and interpreting contracts, Trilogi attorneys are extremely effective in eliciting payer compliance via the phone, through attorney/clinician-written appeals, and in pursuing allowable penalties. Our goal is to quickly recoup denied claims due to:
- Terminated coverage
- Preexisting condition
- Experimental / Investigational
- Self-inflicted
- Policy exclusions
- Rescission
- Timely filing
- Non-covered benefit
- Contract term disputes
- Usual and customary
- ERISA self-fund plan delays
Financial
Our revenue recovery experts are well-trained in billing and coding requirements for Medicare, Medicaid, and all commercial payers. Unlike many of our competitors, we do not focus on merely updating the status of your claim. We are experts at resolving the issues that prevent reimbursement in the first place, and in expediting payment. Our teams effectively escalate issues to supervisors and management representatives at payers and government entities, to ensure timely and accurate resolution of delinquent claims. Our analytical acumen in hospital and payer accounting practices, ethical policies and procedures, and commitment to accuracy, also ensures timely resolution of issues involving:
- Billing/coding
- Coordination of Benefits
- Contractual underpayment
- Stalled and delayed claims
Why we're different
The holistic Trilogi approach produces superior, sustainable results by:
- Providing a unique and collaborative approach blending people, process, and technology with our extensive clinical, legal and financial expertise to maximize payer collections quickly and accurately.
- Delivering evolving client programs and relationships to meet the challenges of increasingly complex regulations and payer strategies to delay and deny payment.
- Developing strategic partnerships. Trilogi is more than an outsourcing service. Working in conjunction with your organization, we focus on root cause analysis to help you identify opportunities for process improvement, while keeping you current on industry knowledge, technology, processes, and best practices.
The Trilogi Advantage
Our clients work with Trilogi to partner with the highest level of technical expertise available in the market, flexible program development, evolving programs to meet changing needs, and low claim-to-collector ratios of approximately 250:1. We supplement your resource shortages and put the fewest feasible number of claims in front of the highest-level resources. Our services are not to be confused with transaction processing programs offered by other vendors who put 1000+ claims in front of a collector with a script. We are experts at claims resolution services which gain the attention and respect of your payers.
Programs
Trilogi's multidisciplinary perspective makes us unique and provides us with significant advantages over typical revenue recovery services. Our blended teams of clinical experts, attorneys and financial analysts understand how insurance, billing and collections practices, technology, and decision making in each area affects your revenue cycle.
In addition to assisting your organization with immediate revenue recovery issues and opportunities, our collaborative team approach helps you improve your organization's knowledge, access to quality data, and implementation of denial avoidance measures.
Reimbursement Services
- Complex and Denied Claims Program
- Commercial and Government Health Insurance Follow-up
- Underpayment Recovery Program
- A/R Cleanup and Customized Projects
- Workers Compensation Program
- Motor Vehicle Accidents and Third Party Liability
- Fiscal Year-end Cash Acceleration
- System Conversion Services
- Legal Services and Litigation Management
Consulting and Education Programs
- RAC Program
- Case Management Consulting Services
- Customized Training for Business Office Staff
URN (Utilization Review Nurse) Clinical Team Services
The URN Team consists of Registered Nurses with experience/expertise in a variety of clinical arenas including Emergency, Critical Care, Cardiac, Neurology/Neurosurgery, Medical/Surgical, Rehabilitation, Obstetrics, Newborn, Orthopedics, Radiology, Case Management and Utilization Review.
Services provided to our clients by the URN Clinical Team include:
Review of MR and supportive documentation for Medical Necessity criteria.
- A formal URN Report is written for the appeal process
Types of Clinical Denials reviewed by the URN Clinical Team include:
- Level of Care (LOC)
- Length of Stay (LOS)
- No Authorization
- Non-Emergent
- Readmission
- Experimental/Investigational
- Coding/DRG verification
- Worker's Compensation (to determine if MR supports claim is WC-related)
- Pre-existing conditions
The URN Team works with a variety of authoritative resources, including:
- Industry Standards/Guidelines for medical necessity
- CMS regulations and guidelines
- Payer-specific Medical Policies
- Medical literature research for Standard of Care
Other work processes performed by the URN Clinical Team include:
Trending of issues with recommendations for Process Improvements for Case Management and/or Revenue Cycle to reduce denials. Issues include:
- Billing Error/Wrong admission status billed
- Medical Necessity criteria not met for admission status ordered
- Coding errors and/or validation of medical necessity
- No pre-certification
- Length of Stay issues (Delay in Discharge; Delay in Treatment)
