Our audit analyzes every remittance received in a 12-to-24-month period to determine contractual compliance of each reimbursement. Our team then works with the payers to recover underpayments that are due our clients.

Critical Addition to Your Revenue Cycle Management

Our underpayment recovery service is a risk-free addition to your Revenue Cycle Management (RCM) efforts. Our forensic audit is performed on remittances AFTER all other RCM efforts have been completed including other internal or external underpayment recovery efforts. We only engage remittance files that our clients expect no further revenues. Therefore, our services compliment all other RCM efforts and provides new revenues…100% of the time.

100% Success Rate

Our results are unrivaled. To date we have analyzed billions of dollars in reimbursements and remittances against 1,000s of unique and often complex payer contracts and have found noncompliance and underpayments for 100% of our clients. The typical result is 10%-20% of gross payer receipts in recovery.

Risk Free Engagement

We work solely on a contingency basis. There are no upfront fees, costs, ongoing tasks required from our clients. We take on 100% of the risk and effort to recovery revenues for our clients. We are only compensated when we successfully recover underpayments.

PROVEN PROCESS

Our team of contract specialists reviews each payer contract in detail and loads the contract payment rates and specific terms into our software system. We also work with the healthcare provider’s billing Department and claim clearinghouse to electronically upload your ANSI ASC X12 837/835 files using our

Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant, proprietary encryption platform.

Our software development team then writes custom algorithms specific to the client’s contract rates and terms to perform the forensic analysis.

Our team of experts and software logic identifies and reviews the variances in the actual reimbursement versus the payer’s contractual obligation.

As the healthcare providers partner, we will work closely with their staff to strategize and devise a plan to proceed with recovering revenue lost due to underpaid, suspended and incorrectly denied claims.

SUPERIOR RESULTS

We have analyzed billions of dollars in reimbursements and remittances against 1,000s of unique and often complex commercial contracts and have found noncompliance and underpayments for 100% of our clients. The typical result is 10%-20% of collections from payers.

Sample Case Studies:

• 123-bed Texas hospital: $6 million in underpayments through BCBS alone.

• 142-bed Louisiana hospital: $10 million+ in underpayments for top 4 payors.

• Large Pennsylvania Private Hospital: $1.2 million in underpayments

from their 4th largest payer. Represents 18% of their collections for the payer.

• A hospital network: $30 million in underpayments from just three facilities.

• A large Ohio physician group: $7 million in underpayments in BCBS professional alone.

• A Tennessee clinic: $1 to $1.5 million in underpayments per payer contract

• Small Texas Community Hospital: $4,048,555.44 in underpayments

from BCBS alone.

• A Missouri hospital: Over $20 million in underpayments

PERFORMANCE BASED EXPERTISE

Forensic analysis to determine contractual compliance and recover underpayments for our clients is our primary corporate expertise. We are the only provider in this space with this sole corporate mission. Given we are undiluted with other pursuits, our results are demonstrably superior to others who offer similar services as an ancillary. Furthermore, we operate on a performance only basis in that we are paid a fraction of what our clients actually receive in underpayment recovery.

Frequently Asked Questions

What is the cost?

$0 upfront fees. We fund all the cost and risk including contract load fees, appeals processes, audit and training which is applied to our recovery fee. Our fees are 100% paid by a % of recovered underpayment fees from the initial audit of past claims.

Where do the underpayments go when recovered?

All underpayments are paid directly to you by the payers. We will bill you a % of recovered underpayments after you have been paid.

What do you expect to recover in past underpayments?

The Underpayment System historically uncovers 5-30% of commercial payments which have been paid incorrectly on every analysis. Our collection statistics for commercial payer underpayments are 85-90% of identified claims. The majority of contracts allow providers to appeal claims that have been underpaid or paid incorrectly for up to 12 months from the last response by the insurer.

After 12 months, they will expire, at which point you will never be able to bill or collect.

Our system recovers additional underpayments owed on zero balance accounts. Dollars underpaid after EMR/EHR and billing systems have fully processed claims as “PAID IN FULL”.

How long does it take to complete your analysis audit process?

Minimum facility time is 30 minutes or less to upload 835-electronic billing records through our proprietary encryption platform, which uses the highest HIPAA standards. Once we have received all contracts and data files it typically will take around 14 days to complete the analysis and start the appeals process.

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