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Adreima’s Post-Payment Recovery program ensures that hospital clients have been fully and properly reimbursed on zero balance accounts, producing “found” revenue from accounts the hospital had considered closed. In addition to recovering additional revenue, our Patient Account Specialists and Clinical Audit Nurses utilize the evaluation of specific claim details to identify trends and issues causing underpayments so that these systematic problems can be resolved and future claims paid correctly.
The complex reimbursement methodologies of Medicaid and other government and private payors make it very difficult for information management systems and patient accounting team members to determine if payments are correct. All too frequently, payments are accepted that are well below the correct amount. Our specialized team of experts reviews claims that have been brought to a zero balance status through payments and/or adjustments to determine if additional recovery is possible. We then re-bill and follow up on those claims until appropriate payment is received.
- Opportunity to identify additional reimbursements, without having to dedicate hospital staff or resources
- Identification of nuances that prevent proper payment to enable process improvement down to the departmental level
- Contingent billing – Adreima bills a percentage of recovered reimbursement, providing a no risk proposition to our clients
- Expert reviews by Registered Nurses and Certified Coders utilized as a resource through the entire reimbursement process
- All work can be completed off-site and documented in the hospital patient accounting system for easy reference by hospital personnel