Revenue Recovery

A 210 bed community hospital recovered $1.1M through our revenue recovery services.

REVENUE RECOVERY SERVICES

Ascend and its highly experienced affiliates, offer providers a comprehensive portfolio of Revenue Recovery Services designed to make an impact on the bottom line. We tailor all of our specific offerings to work within the parameters and processes currently in place in your facility’s Central Business Office [CBO] and Patient Financial Services [PFS] operations. Through successful engagements, we have been able to demonstrate an actual improvement to margins while eliminating risk and expense to the hospital in the process.

We do this by working on a contingency fee model. Thus, you compensate us only when we recover revenue for you.

Our team with years of experience in providing such expert services to the hospital revenue recovery sector brings forward the required expertise in all areas of regulatory, insurance and legal matters. Together with your financial team, we will identify those areas in which to target first, develop a clear path to recover revenue associated with it, and execute the steps to produce results -- on a fully-outsourced basis.

BENEFITS

  • No Risk. Since we work strictly on a contingency fee basis, there is absolutely no cost to you if we do not recover revenue.
  • No Upfront Fee. We handle all project assessments, data collection and compilation tasks without any upfront charges to you.
  • No Overhead. We perform all services on an outsourced basis, allowing your staff to continue to fully focus on their day-to-day activities without distraction or time commitment.

Portfolio of Revenue Recovery Services

Labor and Delivery Recovery

Our analysis and process will identify L&D OP services that your hospital is simply not billing – yet are fully allowable under the payer contracts. In most managed care contracts covering maternity, payment for labor and delivery is based on a flat or fixed fee, except in those instances when complications arise. In best practice hospitals, labor and delivery accounts for about 75 percent IP and 25 percent OP. During one client engagement, we discovered that a large community hospital with approximately 6,000 annual births omitted almost $1,100,000 in services that should have been billed.

Transfer DRG Recovery

Our approach in this recovery area mirrors the CMS system of checks and balances and utilizes a combination of our proprietary software and input from experienced staff. Our team has years of hands-on financial, reimbursement, and compliance experience in both the acute care and post-acute care settings and is well-versed in all relevant Medicare regulatory requirements. We also examine often overlooked Medicare Advantage (and other related payers) claims. Unlike competitors that rely strictly on software, our results produce a significantly higher percentage of revenue recovery.

Probate Recovery

Our probate recovery service follows the model successfully employed by banks, credit card companies and utilities to prevent the loss of potential revenue as a bad debt or charity write-off. We act as the hospital’s single point of service to obtain the co-payments and deductibles that are due from cases that are in probate, a very time-consuming process. We assume that administrative burden and can track patient release to home, hospice or SNF across 7,500 counties nationwide to ensure your recovery of unpaid fees.

Small Balance |High Volume Claims Administrative Appeals Recovery Program

Most of the facilities ignore or do not have time to handle small balance claims. Handling them involves a lot of work and cumbersome appeal's process. With eAppeals® patented form and automated process handling of small balance, high volume claims' Administrative Appeals Process has never been so easy.
Formal administrative appeals are filed for every claim that was denied, underpaid or not addressed at all, perpetually until closure of the claim for all 3rd party commercial claims, managed Medicare and managed Medicaid, and in some states, state Medicaid. This unique process allows scaling up through a mass production approach to work thousands of claims I appeals with a single effort — making it incredibly efficient and cost effective. In addition to on-going appeals work, process includes historical look back to 18-24 months (or more) for the found money. Competition is slow and mired by calling on each claim versus fully automated Administrative Appeals Program.

Managed Care Contracting | Contract Performance

Our professional managed care contracting services for hospitals range from comprehensive review of all major contracts against key performance indicators, to assessment of contract performance and profitability, to strategic advice and negotiation in creating contracts that ease administrative burdens while maximizing revenue. We use a variety of analytical tools to model capabilities for all reimbursement methodologies. We perform on a fully out-sourced basis or on individual projects.

Silent PPO

Our process consists of a “reengineering” of the retrospective process that permits payers to utilize aggressive discount shopping to a solution that allows hospitals to eliminate unauthorized claims re-pricing and aggressive fee negotiations. Our analysis provides evidence so you can prevent payment abuse from occurring while ensuring prompt and accurate reimbursement. We verify and eliminate mis-registered top tier claims, streamline non-contract accounts and remove recurring discount abuse by payers.

Third Party Liability [TPL]

Our process consists of a reengineering of the retrospective process that permits payers to utilize aggressive   discount shopping to a solution that allows hospitals to eliminate unauthorized claims re-pricing and aggressive   fee negotiations. Our analysis provides evidence so you can prevent payment abuse from occurring while   ensuring prompt and accurate reimbursement. We verify and eliminate mis-registered top tier claims, streamline   non-contract accounts and remove recurring discount abuse by payers.

Medicare Bad Debt

Our services ensure that hospitals are appropriately reimbursed for all Medicare bad debts by developing comprehensive, accurate listings of current and prior eligible accounts that will withstand scrutiny of a Fiscal Intermediary audit. In addition, we support the fiscal audit of the list, develop strategies for calling back collection agency accounts and create an improved billing and collection support process that satisfies the new regulatory changes.

Medicaid Eligibility

Our expertise and assistance increases the likelihood of qualifying patients for financial assistance in a timely manner through on-site presence at hospital emergency departments and through ongoing support services to patients throughout their certification process. These activities, coupled with our software tools, not only speed the application process but provide necessary reporting documentation to meet state and federal requirements.

We assist patients in a number of ways through our multi-lingual staff, from obtaining necessary documents to making transportation arrangements to the Department of Human Services and the Social Security Administration. If coverage is denied, we assist in the appeals process and offer counseling on alternative financial options.

Revenue Cycle | CBO Outsourcing

Our customized approach to hospital accounts receivable management creates process improvements that align providers with organizational and financial objectives and ultimately enhances the ability to increase revenue and reduce bad debt. Our consultative workflow analysis begins with the account bill and moves through each step in the revenue cycle. We combine our expertise with our IT infrastructure to deliver consistent, measureable results.