Detect Underpayments from Payers
Juggling contracts from dozens of payers, many short-staffed providers find it impossible to make sure payments meet their contracted rates. Research reveals that providers lose one to three percent of their net revenue annually due to underpayments from commercial payers.
MD Clarity’s RevFind ingests, digitizes, and analyzes contracts, consolidating them in a single location. It compares every payment to payer contract terms and alerts staff to any discrepancies. Pursuing underpayments can result in millions of dollars in cash recovered and improved margins.
Recover every source of underpayments
Focused on recovering the revenue locked up in denials, today’s providers tend to overlook underpayments. Work overload during a staffing shortage, plan complexity, and staff unfamiliarity with underpayments are three significant barriers to the pursuit of this earned revenue.
When providers find the trends in their underpayments, they can recoup meaningful revenue.
Payers underpay when they:
• make processing errors (one AMA study found payer processing error rates were 19.3 percent)
• fail to include agreed-upon annual escalators in the payment
• incorrectly bundle services
• fail to include the late fees that have accrued due to their failure to meet negotiated payment timeframes
• incorrectly interpret services as those they’ve carved-out and attribute payments to a secondary payer assigned to handle those services
• incorrectly combine accounts
RevFind examines all these problem areas - and several others - when tracking underpayments. It even finds underpayments arising from revenue cycle errors made on the provider’s side, such as from staff mistakes on invoices, diagnoses, coding and modifiers, charge capture, DRG validation, and transfers. After identifying underpayments, RevFind automatically delegates them to the appropriate staff for reconciliation, all without the need for a manual and time-intensive spreadsheet process.
Track and analyze payer performance
Payers are partners in your business success, but too many financial disputes seem to go in payers’ favor. The contracts between you set the rules for your interactions, and you have every right to keep payers compliant with their contract terms.
Not all payers pay the same, however. RevFind's dashboards and reports reveal just which payers are diligent in paying their contracted rates. For payers that are shortchanging you, drill down into service types and CPT codes for complete information.
This information alerts you to the payers who aren’t paying what they’ve contractually promised - or whose contracted rates lag those of their competitors. Better yet, it gives you the ammunition to explore and rectify the root cause of these issues.
