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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Recover Revenue & Maximize Reimbursement

underpayment-audit-recovery-identify-correct-root-causes-of-denials

Identify and correct root causes of denials to improve your clean-claims rate.

underpayment-audit-recovery-streamline-workflows

Streamline workflows for greater efficiency, faster appeals, and improved cash flow.

underpayment-audit-recovery-reduce-cost-of-managing-denied-claims

Reduce your cost of managing denied claims and the administrative burden on staff.

underpayment-audit-recovery-help-reduce-regulatory-risk

Help reduce regulatory risk with improved compliance.

underpayment-audit-recovery-rely-on-our-auditing-expertise

Rely on our auditing expertise to resolve underpayments.

underpayment-audit-recovery-help-improve-revenue-cycle-management

Help improve revenue-cycle management and financial performance.

Drive Improved Financial Performance

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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.
underpayment-audit-recovery-payer-audit-services

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.
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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.  
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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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