Leverage 30 Years Of Medical Billing Expertise and Auditing To Recover Upto 20% Lost Revenue On A Contingent Basis
Hospitals are the backbone of a community and the health insurance companies' job is to minimize the payments of claims. Our job is to hold these payors accountable. Where we are different is we analyze 835 Denials and Processes looking for tendencies' that most all internal and external billing auditors miss.
By going beyond the standard variance report, BillingAuditors assists hospitals and healthcare providers and can significantly increase their lost revenue. For instance, one hospital was able to recover over $55 million in underpayments by addressing issues with alternate revenue code logic. Upon investigation, it was found that the hospital was using an incorrect revenue code (250) to represent a high-cost drug to insurance carriers. By switching to the more appropriate revenue code (636), the hospital was able to receive a reimbursement of 60% of charges from one payor, compared to $0 with the previous code. This small nuance resulted in a $30,000 difference in reimbursement on a single claim. It is vital to address such discrepancies, as they may be overlooked as not technically an error and may not be visible on a variance report. If left unresolved, these oversights can lead to millions of dollars in missed revenue annually for healthcare providers.
To maximize revenue recovery, hospitals and healthcare providers need to adopt a holistic approach to their underpayment strategy. Many are unknowingly leaving money on the table by not considering all aspects of identifying and resolving underpayments. The amount of net revenue lost to underpayments varies based on factors such as the complexity of payor contracts, the effectiveness of underpayment management efforts, and the overall health of revenue cycle operations. By thinking beyond simple payment variances, healthcare providers can ensure that costly underpayments are promptly identified and resolved, thus preventing future instances of missed revenue.
Establishing a successful underpayment program is crucial for healthcare providers seeking to recover lost revenue. It is essential to go beyond the variance report and implement comprehensive strategies for identifying, recovering, and resolving underpayments. This could involve analyzing payor contracts for potential revenue code discrepancies, closely monitoring reimbursement rates, and proactively addressing any issues that arise. By taking a proactive and holistic approach, hospitals and healthcare providers can increase their revenue by capturing previously missed reimbursements.
Healthcare providers should not solely rely on variance reports but instead adopt a comprehensive approach to identify and resolve underpayments. By addressing issues such as revenue code discrepancies, providers can recover significant amounts of previously lost revenue. A successful underpayment program requires a holistic strategy that goes beyond simple payment variances and encompasses the complexity of payor contracts, effective underpayment management efforts, and overall revenue cycle operations. By implementing such a program, healthcare providers can maximize revenue recovery and prevent future instances of missed revenue.
BILLING AUDITORS - What We Do
WE FIND THE NEEDLE IN THE HAYSTACK AND OUR SUCCESS RATE IS UNMATCHED IN THE INDUSTRY.
Identify
835 and 837 are both crucial components of medical billing, serving different purposes yet working together seamlessly. The 835 transaction, also known as the Electronic Remittance Advice (ERA), is the electronic version of a paper Explanation of Benefits (EOB) statement. It is sent by the payer to the provider and contains detailed information about the claim payment, including the amount paid, the portion covered by insurance and the patient responsibility, and any adjustments or denials. The 835 transaction helps streamline the payment process, allowing providers to reconcile their accounts receivable and identify any discrepancies or potential issues.
System Creation
The 835 and 837 transactions play complementary roles in the medical billing process. The 837 is used by the provider to submit claims electronically to insurance payers, streamlining the claims submission process. The 835 transaction, on the other hand, is the electronic remittance advice sent by the payer to the provider, providing details of the claim payment. When used together, these transactions enhance the efficiency and accuracy of medical billing, helping providers to reconcile their accounts and receive timely reimbursements.
Iterate
On the other hand, the 837 transaction, known as the Professional (837P) or Institutional (837I) claim, is used by healthcare providers to submit claims electronically to insurance payers for reimbursement. The 837 transaction contains a wealth of information about the patient, provider, diagnoses, procedures, and charges associated with a specific encounter. This transaction streamlines the claims submission process, significantly reducing administrative burdens and accelerating the reimbursement cycle.
How To Overcome the One Year Lookback Period by Identifying Patterns Historically Being Underpaid
EMR systems and data dumps are all what we do on a daily basis. We never need access to your internal systems. A simple data dump from the last year as far back as 5-10 years aids us in identifying patterns. Once the pattern is identified then it's game over. How big of a problem are underpayments by private insurer payors and Medicaid and Medicare?
We will uncover and recover these funds usually within 90-120 days of being given the file. We never get files until after your internal revenue cycle team and other 3rd party vendors are done working the file (usually after 90 to 120 days). How can we be successful if everyone else has worked it and failed? That is all we do. We internally design and build one of a kind software for your specific need.
MyAvatar, Waystar, Great Plains, Optum Pay, NextGen, Nthrive, Ehr and Intelicode
Our AI and machine learning systems will be like adding a team of experts for redundancy.
Usage of ICD-10 and CPT codes are not homogeneous across every provider. Software engineers and coding generated for your specific purpose is what we do. No hospital, medical group or physician network is the same. We build from the ground up for each entity guaranteeing success.
From Our Blog
Billing Auditors Works on a contingency basis on aged accounts. Usually 90 days old or older. These have been worked internally or by one of your vendors and are considered completed. That is where our magic happens.
