Underpayment Recovery Services

It has been consistantly proven that there is between 4%-7% of healthcare provider organizations annual revenue left behind as underpaid claims. Think about that, for every 100 claims up to 7 are left behind unpaid which in most cases leads to Millions of Dollars annually. Most business leaders would call that insane. Utilizing the TBS approach to this it won't cost your organization anything up front to find out how much has been left uncollected. We will do a twelve month audit review on all zero balance accounts on consignment. You only pay us a percentage of the funds we collect after the process is complete.

360 degree 

 TBS will perform a 360 degree retrospective review of the claims
from a Billing, Coding & Reimbursement perspective (including
inappropriate denials, missing follow-ups or non payments,
Contractual updates and Payment variances)in an effort to collect
every dollar then identified as an underpayment.

 The approach adapted by TBS to the Underpayment recovery process is to be able to maximize the identification of underpayments through optimized efforts, considering the time constraints. Hence TBS does not conduct a 100% review of the paid claims, but directs the focus of the analysts to the claims with the highest probability of underpayments. Our data mining tools and predictive analytics help in streamlining the audit process and categorize the claims under various clusters. These claims are reviewed based on the priorities assigned to various claim scenarios. We then review based on recovery opportunities as well as the historical underpayments identified and the potential of underpayment amount in the current data set. 


Underpayment Recovery Process

Underpayment Recovery Services Process Flow

 


Features and Benefits of the TBS Underpayment Recovery Process:

UPRS Features

  • Claim review initiated once the client “closes” the accounts as zero balance, either on receiving the claim payment or adjusting/writing off the open balance on the claims

  • Deployment of Proprietary data mining tools and predictive analytics engine utilizing custom developed algorithms

  • 360 Degree review with identification of underpayments and trend ideas from claims which were deemed as correctly paid / adjusted as zero balance by the client

  • Identification and correction of contract management issues, providing critical insights into the complex payer contracts affecting the provider reimbursement

  • Identification of underpayments accounting for up to 7% of the billed claims with Recovery Rates exceeding 80% of the underpayments identified 

  • Improved billing procedures through interaction and review of claims issues with the staff providing the audit 

 

 For more information or to be provided an estimated recovery of funds from our Underpayment Recovery Audit Contact us Here!

 

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