Today’s healthcare providers are faced with shrinking margins due to declining reimbursements and increasing costs. Providers can also lose millions of dollars every year to underpayment of insurance claims. These underpayments often fall through the cracks because of complex contracts with insurers or because of the unique services your institution performs. The financial impact can result in a loss of annual net patient revenue.

To address this issue, many healthcare providers employ staff and apply technology solutions to capture third-party payer underpayments and execute recovery processes. However, it can be extremely difficult to develop internal expertise to achieve effective management of underpayments and also recover lost revenue.

Exela offers a solution that’s proven and can be implemented quickly with no upfront fees and minimal expense.

Our Provider Revenue Recovery solution can meet your needs and garner your organization significant, unidentified and unrecognized revenue. Our Exela | Insight enterprise contract management system helps you to recover funds and can positively impact your bottom line in a number of ways.

For over 20 years, Exela has provided Revenue recovery services to over 500 healthcare provider organizations. To date, we’ve analyzed over 50 million healthcare reimbursement claims, allowing our clients to identify and recover in excess of $2 billion in underpayments.

We upload all your third-party payer contracts, including key details such as contract effective dates, fee schedules and all 837 & 835 claim data. The complicated payment calculations, based on the terms and conditions in these contracts, are established via pre-programmed rules. There is no limit to the number of contracts or amount of patient data that can be uploaded and analyzed. With our streamlined start-up processes and simplified data import from virtually any system, you can begin to realize recovered cash flow within 90 days.

Retrospective Underpayment Identification and Recovery

Exela | Healthcare can review the most recent three years of reimbursements for every third-party payer used by your patients.  Our experienced staff of certified public accountants, registered nurses and financial analysts, using the Underpayment Identification and Recovery review program, can typically recover 5% of net patient service revenue, and can often identify more. Additional benefits can be realized by reviewing current receivables where our services help prevent contractual reimbursement time limits being missed. This alone can improve your cash flow from net-patient service revenue by from 2 – 4%.

Exela | Healthcare’s streamlined start-up processes and simple data import for virtually any system allow clients to receive additional reimbursements just 90 days after our services begin. Other features of our service include:

• Review of third-party contractual reimbursements for most recent 2 – 3 year period
• Specialize in complex contract terms and high severity provider services
• Flat UB file data request includes 837, 835, and payer agreements
• Payment file (Primary, Secondary, and Self Pay)
• Exela loads and maintains all payer agreements

Concurrent Underpayment Identification and Recovery

Our Contract Management System can also monitor third-party contractual reimbursement of final billing for each patient. We can identify and pursue underpayments at the initial payment, ensuring that no contractual reimbursement time limits pass.  Utilizing this process can improve your current cash flow by 2% – 4% of net-patient service revenue.

Features of our Contract Management System include:

• Identify and pursue all underpayments at time of initial payment
• Review and monitor all claims at the time of final billing
• Contingency fee based on monies identified and collected from third-party payers
• Exela loads and maintains all payer agreements