Denials & Revenue Recovery

AN UNDENIABLE DIFFERENCE

60-70% denial overturn rate on average
Recovering revenue loss from denials takes a lot of effort and time.  Don’t burn out your team, use ours. 

Our team of experts knows exactly how to successfully manage every phase of the process – from denials and appeals, to recovering variance in payments, to finding missing reimbursements. Let our people + our tech capabilities do the heavy lifting.  
 

DENIALS MANAGEMENT

We automate your denial and appeals management process like no one else. Our proprietary Denial AI delivers true AI machine learning (ML) and real automation (RPA).

We built our technology with custom, predictive modeling to tackle post-denial accounts, providing an accurate prediction of expected AR Return, timing of payment, and enforcement of payer contractual provisions. Our system segments denials, predicts the types of appeals most likely to overturn them, and provides automated appeals ready to send or that serve as a foundation for clinical appeal staff. Our clients experience a 60-70% denial overturn rate on average.

Plus, you’ll have direct access to our dedicated team members who will put their decades of experience to use, effectively appealing and overturning denials on both a retrospective and concurrent basis. 

Capabilities Include

Pre-claim Coding Analysis

  • Registration and eligibility check 
  • Coverage and benefit confirmation 
  • Notification of split coverage and COB issues 
  • Updates to payer classification 

Pre-Billing Review 

  • Authorization sufficiency and authorization requirement review 
  • Contractual or regulatory exclusions 
  • Service coverage details – clinical and administrative policies 
  • Case Management Review and Support


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PAYMENT VARIANCE RECOVERY

Don’t let leakage erode your margins. Med-Metrix identifies instances of underpayments and lost charges. It aggregates data from multiple sources to recover the large dollar claims and also the “death by a thousand cuts” underpayments. 

We quickly and efficiently identify one-off “hard dollar” cash recoveries and provide you with detailed feedback on systemic issues and prospective “soft dollar” benefits. 

Our Managed Care Contract experts handle everything – from contract load, identification, billing follow-up, and ultimate recovery of variances – without imposing on your staff or disrupting any operations. You don’t pay unless we are successful. 

Here’s what you can expect:

  • Rigorous scrubber identifies all variances
  • Unparalleled reimbursement intelligence – AI tech allows you to go beyond recovery of large dollar claims to aggregation of small dollar, high volume issues
  • Gain experienced operators to handle billing, follow-up, and recovery of variances
  • Contracts loaded by Managed Care experts
  •  Discover systemic issues to close payment loopholes and prevent future revenue leakage


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TRANSFER DRG

Our experienced team and custom-built technology analyzes patient accounts and claims to determine the proper use of CPT, HCPCS, and DRGs. We identify transfer eligible accounts and potential missing reimbursements. 

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RELATED SERVICES + TECH

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We have delivered an ROI of 8 to 30x for clients who supplement hospital-employed Physician Advisors with our experts.

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This tech automates processes, focuses staff, and drives better financial performance.

Patient Intake Stack

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From scheduling to staff workflow to ensuring correct payment, we’ve built the tools to make every aspect of patient interaction run smoothly.

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Relentlessly raising RCM netback. 

Med-Metrix delivers remarkable value for hundreds of leading healthcare systems and physician providers across the country. 

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