Revenue Recovery Strategies

Electronic Medical Record (EMR) systems are well tuned to ensure that healthcare providers collect every dollar that is on the explanation of benefits as the allowable charge. However, EMR systems are not necessarily designed to ensure that the provider has been paid for what is contractually owed to them for individual procedures or groups of procedures based on that provider’s specific commercial insurance contracts. Our partner firm has developed a proprietary process that allows them to convert client contracts into a database and compare what should have been paid contractually against what was reimbursed based on the explanation of benefits.

Medical Underpayment Recovery

Access Discount Healthcare is our business partner (https://adhcunderpayments.com/). Their specialty is underpayment recovery through their Medical Underpayment Review and Recapture Program.

Their tools:

• Team of payer contract experts
• Most advanced forensic audit software system in the healthcare space
• Analyze paid claims to determine contractual compliance of each reimbursement
• System goes to work AFTER all claims are paid and AFTER all internal auditing and surveillance activities are complete
• NO UPFRONT COSTS; paid on a contingency basis once reimbursement has been recovered by the healthcare provider
• Access Healthcare takes 100% of the risk and effort to recover funds

Their market position:

• Hundreds of clients across the United States
• Billions of dollars of reimbursements and remittances audited
• Thousands of unique and often complex payer contracts audited

Their results:

• Found reimbursement non-compliance and underpayments for 100% of client base
• Typical results: 10-20% of gross payer receipts in recovery

Visit their site at https://adhcunderpayments.com/ for more information and blinded case studies