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.

Our outcomes

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Infographic

Are You Ready for the No Surprises Act?

Infographic

Are You Ready for the No Surprises Act?

How are payers feeling about the No Surprises Act’s Advanced EOBs and ID Card Requirements? We break it all down in this infographic.

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On-demand Webinar

Coordination of Benefits: A Line of Defense Against Overpayments

On-demand Webinar

Coordination of Benefits: A Line of Defense Against Overpayments

Explore the benefits of developing and augmenting a first line of defense against overpayments with a multifaceted approach to Coordination of Benefits (COB).

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Video

A Comprehensive, Prospective and Retrospective Approach to FWA Identification

Video

A Comprehensive, Prospective and Retrospective Approach to FWA Identification

Discover invaluable strategies to help eradicate FWA from NHCAA's annual training conference.

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