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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Full-Circle Revenue Cycle Solutions Q1 2021
Confidential and Proprietary Information
Copyright © 2021 Alpha II, LLC. All Rights Reserved
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Alpha II OverviewSince 1980, Alpha II delivers revenue integrity across the full continuum of care by enabling proactive denial intervention throughout the RCM workflow, eliminating revenue leakage, and maximizing reimbursement.
80k+ ProvidersPhysicians, ASC’s, SNF’s, and
other ancillary providers
Broad Market ReachAmbulatory | Acute | Post-Acute
25+ Milliontransactions processed monthly
97% client retention rate
12 yearsaverage client tenure
30+ Channel PartnersPM, EMR, RCM, Clearinghouse
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Revenue Cycle: Pre-Bill & Post-Bill SolutionsRobust rules engine improves claim validity and accuracy, delivers positive cash flow, maximizes reimbursement, and saves valuable staff time through denial prevention.
Adjudication Edits: Accurate and efficient claim adjudication
Pre-BillClinical Coding and Billing Edits:Comprehensive clinical claim and encounter scrubbing solution covering the entire continuum of care
E&M: Accurate, audit-ready coding for evaluation and management services
Advanced Beneficiary Notice of Non-Coverage:If an ABN is required based on medical necessity or frequency limitations, the clinical staff can generate the form on-demand.
Post-Bill
Zero Balance & Underpayment:We identify underpayments, prioritize the high-dollar opportunities and engage your team in meaningful work.
DRG Validation: Advanced rules engine uncovers trends and patterns in incorrect coding
Education: Monthly webinar on denials avoidance/prevention to ensure dollars are maximized early in the revenue cycle.
Denial Avoidance: Root cause analysis to identify and correct issues related to denials and underpayments.
Deep Coding Content Combined with Multiple Edit Severities Enable End-Users to Catch Every Error
Proprietary Content /
Rules Engine
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Incorporates a full suite of professional,
institutional, and quality reporting edits based upon extensive
coding and billing requirements
TailoredTimely ContentProactive Updates Results
Health Information ManagementComprehensive clinical claim and encounter scrubbing solution covering the entire continuum of care
Improves claim validity and accuracy, deliver positive cash flow, maximize reimbursement, and save valuable staff time through denial prevention.
Full Suite Workflow
700M+ transactions managed from 2018 –2020 with an average pre-bill denial rate of 11% identified for our
clients
Content Database Updated Daily
-Institutional and
professional edits-
Different specialties
Verifies encounter and claim data from the
payer’s perspective and allows for corrections
prior to filing.
Designed to deploy across multiple
workflows within the revenue cycle.
Customizable & User-friendly interface
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Designed by a physician and validated by
healthcare consultants, compliance managers,
and auditors.
Eliminates subjective
component of medical decision
2.8k Healthcare Practices representing 11.8k Providers utilize
E&M Generate integrated in their EHR
applications.
Considers additional factors like review of
prior medical records and consultations
Assigns acuity value to every diagnosis based
on the severity and status of the presenting
problem
Assigns risk values to diagnosis codes,
diagnostic tests, and other management options to ensure precise medical
complexity.
Deep Knowledge
Reduces Audit Risk
Proprietary Method Results
Health Information ManagementAccurate, Audit-Ready Coding for Evaluation and Management Services
Patient history and exam elements, combined with a risk and diagnosis acuity, provide the medical decision component and determine the appropriate E&M level of service.
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Medicare patients recognize the Advance Beneficiary Notice of
Noncoverage (ABN) as a necessary step
toward ensuring proper payment for some non-
covered services.
2.9k Healthcare Practices representing 11.9k Providers utilize ABNgen integrated in
their PM/EHR applications.
Tracks services with Medicare policy
frequency limitations
Returns completed ABN and the policy that
triggered the decision of non-coverage
Uses patient’s diagnosis and
procedure to verify medical necessity for
Medicare LCD and NCD policies
Medicare Patients
Simplify Process Deliverable Results
Health Information ManagementSimplified Medical Necessity Verification for ABNs
Per CMS, a knowledgeable practice representative must explain to the patient why the service is non-covered, the options to receive or deny the service, and provide an accurate cost estimate for the service all before asking for a signature.
Using demographic information to complete ABN
Simple interface generates ABN
quickly
Medical Necessity
Medicare Policy
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Verifiable pricing calculation to over a dozen Medicare Fee
Schedules
Denial Prevention: Focused proactive
approach
Specifically designed to deploy across various clinical and financial
workflow
Direct platform integration, or a simple
upload/download (working towards API integration in 2021)
Long time support of the VA’s claims
adjudication process and fee schedule development has
brought additional depth to the
Company’s rule engine
Fee Schedules
Large Partner Integration Results
Health Information ManagementAccurate and efficient claim adjudication
Empower and enable “preemptive” Denial Prevention to maximize your earned revenue. Claims adjudication can be a quick process when a clean claim is received.
Currently used by the VA to price all
of their Community Care claims
Rules Engine Workflow
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
- Line item denials on claims that were paid
- Missing, inaccurate or duplicate claim
information- Medical Necessity- CMS rule changes
- Missing or incorrect modifiers
- Fee schedule updates
Education on denials avoidance/prevention to ensure dollars are
maximized early in the revenue cycle.
Root cause analysis to identify and correct
issues related to denials and underpayments.
Physician practices see between five and ten
percent of claims rejected by commercial and public payers each
year.
We identify underpayments,
prioritize the high-dollar opportunities
and engage your team in meaningful work.
Key Focus
Cash Acceleration
Physician Practices
Denial Prevention
Revenue IntegrityThe Alpha II ZBR team takes it a step further by optimizing your team’s use of our tools to prevent revenue leakage on an ongoing basis.
Industry trends indicate that 90% of denied claims are preventable – the combination of solid scrub rules and continuing training and education that Alpha II’s experts can deliver creates industry best-practice billing to drive that prevention.
Maximize reimbursement –
Alpha II assumes all the risk with
contingency based pricing.
Revenue Intelligence
Root Cause
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Copyright © 2021 Alpha II, LLC. All Rights Reserved
Thank you for your time. We look forward to working with you.
Anna MonsourSales Solutions [email protected]
Alpha II · 2074 Summit Lake Drive · Tallahassee, FL 32317 · USA800-825-7421 | www.alphaii.com
mailto:[email protected]://www.alphaii.com/https://twitter.com/Alpha_IIhttps://www.linkedin.com/company/alpha-ii-llc/
Full-Circle Revenue Cycle Solutions Alpha II OverviewRevenue Cycle: Pre-Bill & Post-Bill Solutions�Robust rules engine improves claim validity and accuracy, delivers positive cash flow, maximizes reimbursement, and saves valuable staff time through denial prevention.Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9