WHAT WOULD YOU DO WITH AN ADDITIONAL CASH BOOST AT YOUR FACILITY?
A concurrent underpayment identification and recovery project encompasses a daily analysis of all third party payer contractual reimbursement. The analysis includes all contractually obligated payers: managed care, Managed Medicare, Managed Medicaid, Traditional Medicare, and Tricare.
The majority of healthcare providers currently dedicate staff and contract management systems to identify and collect underpayments internally. Our service compliments, supplements, or replaces existing processes at your discretion.
Exela begins the process by loading all contractual agreements, calculating the expected reimbursement, and comparing such to the actual reimbursement remitted by the respective payer on a daily basis. Our review, based on industry averages and our extensive experience, will identify additional reimbursement ranging from as low as 2% to as much as 20% or greater, of your net patient service revenue. A portion of this additional reimbursement would have gone unidentified, unrecognized, and uncollected utilizing your current processes.
A key component to a successful analysis begins with patient registration. Exela verifies the correct payer code assignment at time of final billing enabling us to immediately identify underpayments at time of payment. Utilizing our professional staff of certified public accountants, registered nurses, and accountants, our identification and recovery processes, ensure no timely follow-up contractual limitations are invoked. Our query and reporting capabilities allow you to request and review pertinent information previously not available, in a timely fashion.
This is a no risk endeavor. The data required is easy to obtain, Exela requires little or no staff commitment, as we become a subscriber to the current data transmission process. Our fees are completely contingent on the additional reimbursement we identify and recover from your third party payers. This is an ideal analysis necessary to monitor your daily and future reimbursement performance. Exela works with the respective payer on a daily and ongoing basis with the purpose of reducing or eliminating future underpayment occurrences.
This service typically includes a retrospective underpayment and recovery analysis and may incorporate contract modeling and the calculation engine.
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