Revenue Integrity Services

Payment Verification

Payment Verification

Payment Verification

The erroneous application of code-based reimbursement methods create underpayments! Net Revenue's services are funded by the CASH recovered for your facility

NET REVENUE provides sophisticated payment verification services to ensure our clients receive accurate reimbursements according to the contractual agreements with their payers.

Utilizing modeling software, Net Revenue analyzes the last three years of patient accounts to determine if the payer calculated their reimbursements correctly. Whether an underpayment is due to miscalculation or inappropriate denial, NET REVENUE will identify and recover this missed reimbursement.

Better than the Competition
Net Revenue’s professional staff works with you to develop the necessary files in order to capture the billing and medical record data required to calculate reimbursements. Additionally, we capture all payment/adjustment transactions and, through our proprietary process, properly configure the data to determine how the payer has adjudicated the claim. This allows Net Revenue to find underpayments where other firms cannot!
  • NET REVENUE models your contracts and compares the expected reimbursement to the payer’s settlement of the claim. The system is flexible enough to model complex methodologies including multi-tier stop-loss provisions and timely payment limitations.
  • Underpayments are separated into categories to recover systematic errors as simply as possible. This often means working with the payer’s hospital representative to correct payer processing errors and accurately compensate the hospital with lump sum adjustments and/or better future payment terms.
  • Individual cases of underpayment are then worked case by case - contacting the payers and dissecting their process. Where the underpayment is due to denials, we access medical records, enabling us to evaluate the validity of a payer’s denial. Net Revenue’s Clinical and Coding Department will then review both systematic and unique cases of denial to determine the appropriateness of the payers’ actions and recover additional payments where suitable.

In addition to the recovery of cash, the process provides information on payer actions that can be used in future contract negotiations.

Net Revenue works with the Business Office and Medical Records to correct any related deficiencies in your current process. Finally, once the process is complete, NET REVENUE will provide ongoing support at no additional cost.

Net Revenue Identifies:

  • Payer processing problems that continue to underpay claims
  • Contract terms that reduce reimbursement
  • Denial patterns that are inappropriate

Net Revenue recovers CASH, provides information on payer actions, helps to correct deficiencies and provides ongoing support.

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