.: SunStone Consulting | Healthcare Reimbursement & Regulatory Solutions :.

Hospitals that provide care to Pennsylvania workers, are challenged to monitor and ensure they receive appropriate payments by workers' compensation payers. Unfortunately, many hospitals lack the resources required to adequately monitor claims and provide the Bureau of Workers' Compensation important quarterly update information. This process is difficult and confusing, and most hospitals have opportunities to improve their processes and reimbersment.

SunStone Consulting has unmatched expertise in Pennsylvania workers' compensation billing, reimbursement and collections. Since the passage of Act 44 in 1993, SunStone's Jim O'Connell and Tim Mosco have been directly involved with the development of the Bureau of Compensation's regulations, claims processing systems, Application for Fee review process and staff training.

Our process blends extensive clinical and technical experience with a proprietary software edit tool that identifies opportunities to recover underpayments for historical claims.

You can count on SunStone to

Review your top commercial contracts for payment terms and timelines
Process your historical claims to uncover opportunities for adjustment claims
Review medical record and billing documentation, to make recommendations regarding adjustment claims
Estimate the financial impact of adjustment claims
Calculate expected payment by claim, to assist with improved contractual allowances and accounts receivables
Evaluate opportunities to improve cash flow by outsourcing accounts receivable to SunStone

The 3 areas of concern:

Quarterly CAF updates
Payment Validation
Claim tracking and collections

For detailed information about SunStone Consulting Workers' Compensation Recovery Solutions, please contact
Jeffrey St.Clair (jeffstclair@sunstoneconsulting.com).