RSource combines the clinical expertise of doctors, UR nurses, and care management professionals with the legal expertise of healthcare attorneys to provide the most successful appeals for clinically-denied claims. RSource’s comprehensive Clinical Denials Program has two distinct goals, maximizing recoveries on unavoidable denials AND reducing on-going, preventable denials.

Denial Recovery

Simply stated, RSource can recover substantial dollars from clinical denials. RSource maximizes cash through:

Completion of Authorization
& Certification Process

  • RSource quickly resolves nearly 30% of denials via the care management process, including submitting clinicals and engaging the physician’s office.

Combined Clinical
& Legal Appeals

  • Experience proves that an appeal comprised of a clinical review from an RSource medical professional and a demand letter from an RSource attorney gets the best results.

Erisa Appeals

  • RSource has substantial experience with ERISA appeals and guides the patient through the process as a Patient Advocate.

Overflow/Safety Net Staffing

  • Clinical denial work flowing to RSource can be adjusted with the staffing needs/challenges of the hospital, preventing staffing shortages from turning into lost revenue when appeal deadlines are missed.

Denial Prevention

RSource prides itself on making its clients better, helping them to actually reduce denials going forward. RSource accomplishes this by:

Root Cause Analysis
& Monthly Reporting

  • RSource provides useful data back to its hospital clients, identifying the root causes of denials so process improvements can be made.

Educational Workshops /
Hospital Staff Training

  • RSource provides hospital-specific training, highlighting the documentation and process improvements that have the greatest impact on denial reduction.

Regular Project Teleconferences

  • RSource engages all of the hospital stakeholders, from Care Management to Financial Services, to discuss payer trends and issues.

Payer Meeting Representation

  • RSource’s attorneys, experienced with all types of contracts and reimbursement issues, help hospitals improve payer relationships, attending meetings with payers, via teleconference and in-person.