Our Services
Forensic Analysis
Contracting
Analytics / Reporting
FORENSIC ANALYSIS
Our contract specialists load the payment rates and terms of the healthcare providers existing Payer Agreements in the Contract Module. We work with the healthcare provider Billing Department and claim Clearinghouse to upload your ANSI ASC X12 837/835 electronically files using our HIPPA- compliant, proprietary encryption platform. (837 and 835 files are the industry standard files to submit healthcare claims and payment information electronically).
Using these two sources of critical data, our team of experts and software logic identifies variances in the payment reimbursement and the healthcare provider’s contractual agreement with the Payer. The resulting data is organized in an easy-to-use, understandable format.
As the healthcare provider’s partner, we will work closely with their staff to strategize and devise a plan to recover revenue lost due to underpaid, suspended, and incorrectly denied claims.
CONTRACTING
Our Contract Modeler is designed to “plug and play” proposed reimbursement scenarios, rates, and contract terms using historical claim utilization data to determine revenue outcomes based on a provider’s specific case/service mix. This valuable tool allows the healthcare provider to assess the Payer’s contract proposal’s impact and identify opportunities to maximize revenue.
Our team of specialists is experienced professionals having worked in administration, operations, and contracting with major Payers. Consulting services, as well as contract negotiation services, are available.
ANALYSIS / REPORTING
All data elements captured in the electronic 837/835 files are defined by CMS and housed in a secure client-specific environment on your HIPPA-compliant/encrypted server. Medical Revenue Optimization offers a suite of standard claim utilization reports and the ability to provide customizable, user-friendly reports.
This comprehensive capture of all data related to a healthcare service experience provides a picture of the healthcare provider’s need to evaluate current and future operations.
HOW CAN MEDICAL REVENUE OPTIMIZATION HELP?
We will review every payment over the past two years to verify that they were paid in full according to the payer agreements.
Our team of experienced contract specialists will analyze, load, and verify that all contract details have been entered correctly into the platform.
Once your Electronic Claims are uploaded to the platform, we will provide the following details:
○ Any claim setup issues.
○ Breakdown of Payment shortfalls by Payer according to Claim Adjustment Reasoning.
○ Group all Payment shortfalls by collectability.
○ Begin collections on past underpaid claims.
○ Our goal is to initiate collections within ten days of receiving all relevant information.
