Healthcare analytics solutions that are empowering providers reduce cost, recover lost revenue, and make better data-driven decisions.
Managed Care and Government payer contract assessment to identify lost revenue due to Providers
CentraMed’s RevComply services adds lost revenue to provider’s bottom line; typically, resulting in a 1-2% increase in provider gross revenue, over a 12-month period. There is zero investment and zero risk to the provider, as RevComply reviews closed balance accounts. CentraMed receives payment only on recovered revenue. Recoveries begin within one month of start of engagement.
CentraMed RevComply adds a layer of quality payment review for all closed balance claims through a succession of queries that compare the actual reimbursement to the expected contractual allowable – identifying underpaid cases. Once variances are found, the CentraMed RevComply team conducts the research, review and assessment of each variance claim. CentraMed tracks and aggregates recurring underpayment risk areas to stop the trend, on an ongoing basis.
There is no risk and no investment for providers, because the RevComply review is performed on closed balance accounts. Every recovered dollar goes straight to the bottom line. The only cost to the provider is a contingency percentage of what is recovered. This model ensures that RevComply pays for itself by identifying due dollars that are effectively found money.
Our RevComply experts analyzes claim data in yearly sets. CentraMed’s best practice is to review the previous two years’ worth of data; once our review is complete, the provider’s next year of data will be ready to analyze and the program moves into a monitoring mode. The RevComply process begins with a data download containing all claim information, including patient demographics, clinical information, itemized bill information, and transaction history. This data is loaded into our proprietary analytics platform. CentraMed collects copies of the provider’s payer contracts and any contract matrices and models the contracts in the cloud-based CentraMed data warehouse. The claim data is run through a series of queries and macros to independently determine the expected reimbursement due on each claim. CentraMed flags any potential variance or underpayment and conducts a claim-by-claim review to confirm lost revenue. This is done via remote system access and through conversations with payer representatives. Finally, an appeal process is launched with the payer to recover the underpayment. If recoverable, the payer will issue the underpaid balance directly to the provider.
CentraMed RevComply team provides monthly updates on our audit progress. At the conclusion of the review, RevComply team provides a detailed listing of process improvements for the provider. Throughout the engagement each claim is classified and categorized to provide an accurate assessment of areas for improvement within the provider’s revenue cycle. These improvements may be in Patient Access, Utilization Management, Billing or Coding, Contract Management, or in the back office.
CentraMed RevComply services is a zero-risk payment review solution that adds unexpected revenue to provider’s bottom lines – typically resulting in a 1-2 % increase in provider gross revenue over a 12-month period. CentraMed RevComply further highlights process improvement areas which prevent future losses.