Medical Underpayments
The Company & Who We Serve
The company has been in business since 2008 with sole expertise in medical underpayment audit and recovery services. Clients include hundreds of medical providers throughout the country – primarily hospitals, surgery centers, clinics, and large physician groups.
The service complements your existing RCM software and only audits payment files that your team is no longer working on. They work solely on your abandoned files, extracting additional revenue that your business never expected to retrieve.
The platform is not an off-the-shelf product – it is proprietary software that is customized in accordance with the attributes of each client’s insurance carrier contracts. This expertise derives from a team that includes former, senior insurance carrier contract specialists.
Services are designed for medical providers with $75M+ in annual revenue.
Benefits to Your Business
- Audits are done on every payment for a given period (minimum 24 months) to determine whether the payment is compliant with your payor contract and fee schedule. Where you have been paid less than expected, we recover the underpayments from the payors.
- This is a complementary service to your existing RCM software – it does NOT compete with it. Audits are done on payment files that your team has already abandoned. The system also has a definitive data set, including date ranges, that prevent any confusion with your existing system and processes.
- We do an initial data run of your 835 file to determine your particular underpayment trends, fine-tuning the software to maximize your payor recoveries.
- The focus is on payors, including Medicare and Medicaid, NOT patients (for copays, deductibles, or cash payments).
- Fees are contingency-based, so there is no upfront cost or risk. These are all dollars that your business never expected to receive.
Savings
Average underpayment recoveries are 22%, with these client case studies
- 123-bed TX hospital: Over $6M in underpayments via a single payor
- 142-bed LA hospital: Over $10M in underpayments for top 4 payors
- Small TX Community Hospital: Over $4M in underpayments from a single payor
- MO Hospital: Over $20M in underpayments from top payors
- Large PA Private Hospital: $1.2M in underpayments from their 4th largest payor
- Hospital Network: Over $30M in underpayments from 3 facilities
- Large OH Physician Group: $7M in underpayments from a single payor
- TN Clinic: $1-5M in underpayments per payor