Revenue Recovery Service

 

ASSISTING HOSPITALS

GET PAID MORE FOR THIRD-PARTY

LIABILITY-RELATED MEDICAL CLAIMS

 

We have recovered significant revenue for clients 100% of the time!

We know you have billing and a proactive one or two revenue recovery companies but we go beyond them!

We would like to introduce you to our unique and proprietary revenue recovery service, which is an ideal solution for medical organizations as an addition to their current revenue cycle management efforts.

As you are likely aware of and studies have shown, in many cases such as motor vehicle accidents, workers compensation, slip and falls, and medical negligence, healthcare insurance claims are not filed against the proper or ideal insurance carrier (i.e. Healthcare plan billed instead of auto insurance plan).  Due to this fact, Hospitals and providers are not being reimbursed the total potential revenue that they should have received for their services.  In addition, Commercial health plans and at risk managed care organizations including HMO, Managed Medicare and Medicaid, ACO, IPA, MSO all have erroneously paid claims that they should not have been responsible for.

In fact, in a 2015 Government Accountability Organization (GAO) report, the committee reported that 10.5% of the payments made by Medicare alone equating to 59.9 billion US dollars, were wrongfully covered by CMS and should have been covered by other third parties. We specialize in identifying claims that were improperly submitted and paid and rectifies the situation by finishing the cycle through the collections process.

Our cutting edge technology solution simplifies the complex, labor intensive processes required for medical organizations to get paid more for third-party liability related medical claims as well as return the appropriate monies back to the organizations that initially paid out the claims.

Utilizing proprietary software developed with advanced algorithms to analyze an organization claims and payments data files, we help maximize the revenue returned to the appropriate organizations by identifying potential revenue leakage retroactively on claims determined to be uncollectible, underpaid, or in self-pay status and delivering revenue back to the appropriate organization.  Our proprietary system is comprised of algorithms and advanced analytics to cross-reference the file against 50+ proprietary databases along with 20+ publicly available databases to identify claims with potential revenue return on a retroactive basis, according to the statutes of limitations in the respective state that the claim was processed.

We have a proven track record in the recovery space and have shown the ability to find more revenue than any other vendors or internal departments who attempt to accomplish this.

A few key facts and bullet points about our recovery service:

  • $400+ Million Recovered for Hospitals and Health Plans
  • Revenue Recovered amounts from 1-3% of overall claims and depending on state can go back as far as 6 years
  • No out of pocket or upfront expenses to our clients
  • Clients in 46 States / 900+ Hospitals including top Health Systems    
  • Proprietary discovery solution leveraging 70+ sources of key information
  • No Patient Contact ever
  • Proprietary Process to recover lost funds through identifying proper coverage
  • Analyze all zero balance accounts retrospectively 
  • Have recovered significant revenue for clients 100% of the time regardless of other vendors or in house solutions in place
  • Do not have to replace any existing processes or vendors; but rather enhance those efforts as an additional solution

The most intriguing and attractive aspect of our service is that we work strictly on a contingency basis.  We can run analytics on an organization’s existing data in its simplest form and have a report back within days outlining the lost, yet recoverable revenue.  All we need is the claims (835) and payment (837) files and we can go to work.

Please find some additional information attached including our standard file format that we would ultimately need your data after we contracted.

We will gladly execute your standard Business Associate Agreement (BAA) as well.

We will then send our simple two-page Customer Service Agreement for your review and execution as well.

We look forward to working with you and recovering the significant revenue that your organization rightfully deserves.

Hospital Revenue Recovery Service
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Call us today to schedule a WebEx for an overview and to get your questions answered.