Solution Bundle

Underpayment Audit and Recovery

Outsourced underpayment recovery services for hospitals that want to better manage denied claims and quickly correct healthcare underpayments.

 

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RecoverRevenue & Maximize Reimbursement

  • Identify and correct root causes of denials to improve your clean-claims rate.
  • Reduce your cost of managing denied claims and the administrative burden on staff.
  • Rely on our auditing expertise to resolve underpayments.
  • Streamline workflows for greater efficiency, faster appeals, and improved cash flow.
  • Help reduce regulatory risk with improved compliance.
  • Help improve revenue-cycle management and financial performance.

Drive Improved Financial Performance

  • Underpayment audit and recovery

    • We build and model actual contracts and re-price every claim according to contractual rules using proprietary technology.
    • Enable our skilled, experienced staff to advocate on your behalf with payers; we help to quickly resolve underpayments related to interpretations of contract, policy, or documentation.
    • Access our expertise in analyzing payer adjustment codes from remittance advice, including case management and utilization review, to facilitate successful appeal of denied claims.
    • Benefit from our custom-created ‘Gold Standard’ compliance program which exceeds all requirements of the Office of Inspector General.
    • Our clinical and technical experts include skilled nurses and revenue cycle experts, and because our services are system-agnostic, these staff can work your denials onsite or remotely within your existing billing system and EHRs.

  • Payer audit services

    • Leverage our expertise in appealing Medicare notifications to rescind payments via the Medicare Recovery Audit Contract Program (RAC), and to address other commercial and government payer audits.
    • Rely on our team to coordinate medical chart reviews and meet appeals deadlines, alleviating the administrative drain on your staff in patient financial services, case management, and health information management.

  • Ongoing system edit-and-workflow maintenance

    • Depend on our experts to keep your team abreast of regulatory changes. We review and implement payer bulletins and educate your staff via tutorials—all to facilitate a proactive approach to denials management.
    • Engage our team to provide ongoing edits maintenance, workflow modifications, and system cleansing to help ensure your claims submissions reflect payer compliance updates and regulatory changes.  

  • Detailed reporting

    • Gain valuable trending insights as well as specific recommendations for documentation, edit improvements, claims management, and process improvements to address the root causes of denials and to increase clean claims.
    • Leverage our detailed reports on denials and underpayments during payer contract negotiations.

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