Revenue Recovery

Revenue Recovery 2017-09-12T11:48:54+00:00

Most healthcare providers do not collect all of the revenue to which they are entitled. US hospitals lose billions of dollars annually due to incorrect pricing, charging, and coding of services and items related to the care of patients. Most medical organizations are aware of this revenue leakage, yet are unable to resolve the highly complex issues that cause it.

Activara Revenue Recovery specialists have helped healthcare providers recover over $200 Million of these unrealized payments from Medicare and commercial health insurance companies. Our team includes an extensive network of professionals experienced in every category of revenue recovery. We work on a contingency basis, which simply means that we get paid based on how much we recover.

Our free Hospital Revenue Recovery Review will confirm whether or not accurate payment for all services is taking place in your systems. This no-risk analytic assessment includes an audit of past claims to identify areas with a high potential for actionable revenue recovery. Our non-disruptive Recovery process can have a considerable impact on your cash flow within weeks, enhance your balance sheet and ultimately improve the bottom line.

Here are a few of the areas that we specialize in:

LOST CHARGES
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Our team audits Medicare, commercial and managed care claims in order to identify documented items that were not billed by the provider. In this comprehensive service, we also evaluate the coding of the bill to ensure that it accurately represents the services provided. Finally, we compare the payments received from the insurance carriers to the insurance contracts to ensure that the provider received the maximum reimbursement. As missing charges are identified, our recovery specialists bill them to the appropriate insurance carrier for payment. These “Lost Charges” payments are essential to recovering the lost revenue that your hospital has earned and deserves.
ZERO BALANCE ACCOUNTS
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A detailed review of claims that the hospital has determined are paid in full. These accounts have been adjusted to zero, and the hospital does not expect any additional reimbursement. We audit these “Zero Balance” accounts to identify and recover previously unidentified underpayments. Our experienced specialists are trained to locate recovery opportunities that are commonly missed by automated systems. We perform all of the appeal and grievance work required for proper reimbursement. All necessary account adjustments are made, freeing up provider staff to focus on core billing and collection efforts. This comprehensive process ensures that each claim is paid correctly and that the hospital has received all revenues that are payable for the services that it provided.
MANAGED CARE CONTRACTS
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Healthcare industry analysts estimate that underpayments and denials account for a loss of three to five percent of net managed care revenues. Many hospitals simply mark underpayments as contractual adjustments without verifying that the payment was accurate, while overpayments are identified and returned. Often there simply are not enough resources to solve this problem and ensure payment accuracy. Activara Managed Care Contract Recovery delivers a strategic solution that ensures compliance. Our managed care recovery specialists make sure that your hospital is paid correctly by government and commercial managed care payers.

What Is A Hospital Revenue Recovery Review?
Many hospitals in the US lose millions of dollars annually due to incorrect pricing, charging, and coding of services related to patient care. Activara Revenue Recovery specialists help healthcare providers recover these unrealized payments from Medicare and commercial health insurance companies. Our free Hospital Revenue Recovery Review will let you know if lost revenue is available for recovery.

Step 1: Activara analyzes a sample of your hospital’s patient claims data to identify areas with a high potential for recoverable revenue. We then report back to you with the projected recovery results.

Step 2: Your hospital and Activara sign an agreement that establishes terms for the recovery process. The agreement provides access to patient data and hospital information systems needed for a successful recovery project. It also includes the compensation rate, manner of payment and method for tracking the recovered revenue.

Step 3: Activara contacts your hospital’s IT department to arrange for data and system access. We then begin the recovery process by identifying specific missing charges, billing errors and other recovery opportunities. Our team makes the necessary corrections and submits claims directly to the appropriate insurance carriers for payment.

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