Complex reimbursement methodologies and ambiguous contract language are often the reason behind underpayments
STAT Revenue’s review begins with a comprehensive analysis of payer agreements, regulations, and legislation to identify the risks associated with each contract. We take special note of high risk contract language such as readmission clauses, coordination of benefits, and carve-outs for special services. We then utilize this analysis to complete an in-depth review of all related claims to identify underpayments.
Regular project updates are customized to inform your team of the top underpayment trends we uncover. We work directly with your team to ensure revenue integrity by implementing processes to strengthen controls, close payer loopholes, and provide contract language recommendations for future negotiations. In situations where the standard appeal process does not yield results, STAT Revenue can assist in escalating major underpayment issues to achieve resolution.