OUR SUCCESS

WHY IT MAKES GOOD FINANCIAL SENSE TO OUTSOURCE THROUGH US FOR REVENUE RECOVERY:

A 2016 Black Book survey revealed that medical business office outsourcing was slated to increase 30 percent in the next year among practices with 25 physicians or fewer because of declining reimbursement rates and value-based care models.

The survey further reported that 59 percent of medical providers and 86 percent of hospitals said that their organizations plan to eliminate medical billing processes that are resource-intensive, error prone, manual, and back-end. These providers pinpointed five factors other than declining reimbursement that caused their organizations to consider revenue cycle management and medical billing outsourcing, including:

  • Inefficient billing processes
  • High staff turnover rates*
  • Lack of health IT know-how
  • Stress of financial and staff management
  • Declines in direct patient care time

Claim processing is the economic life blood of a practice and a new or replacement employee in the billing department inevitably leads to slowdown in the processing of claims, which means a slowdown in receiving your money.

82% of practices that elected to outsource business office services in the third quarter of 2015 experienced a decline in the number of rejected claims and the time it takes to collect payments from payers during the first two months after outsourcing implementation.

OUR TEAM

  • Our Managing Partner offers 39 Years of experience in the very complex world of Revenue Cycle Management and Recovery
    • Her specialized experience in the medical billing industry, serving multiple provider types including acute hospital inpatient and outpatient services, physician offices, skilled nursing services and labs is what you need working behind the scenes to collect your money.
    • Most companies do not have nearly this level of expertise. She and her team can help get your practice back on sound financial footing.

    • Our Managing Partner led her team to recover $200 million on a $360 million A/R project for a national hospital group – Need we say more?
      • Many companies tout their successes but few can deliver on a project of this magnitude with such a high success rate
      • Our team works with the bulldog tenacity necessary to get your A/R cleaned up, and to keep it from growing out of hand in the future
      • One of our expert team members literally searched through the entire Medi-Cal Billing Manual and found 5 critical words that enabled her to collect over $1 million dollars in previously unpaid ER room charges for a major university teaching hospital that had previously just been writing the charges off. And, this prevented future loss of revenue for the hospital!

THAT’s bulldog tenacity!

OUR TEAM'S EXPERTISE INCLUDES:

  • Experts in all medical specialties as well as Dialysis Centers, Outpatient Rehabilitation Therapy Centers, home health facilities, hospitals and laboratories.
  • Experts in Medicare/Medicaid Revenue Cycle Management, as well as most Commercial insurances
  • Expert in managing commercial appeals, Medicare appeals, ADRs, RAC Audits, MAC redeterminations, ALJ hearings, as well as Medicaid appeals nationwide
  • Highly experienced in specialty A/R collections such as Third-Party Liability, Workers Compensation and Medicare Secondary Payer claims
  • Experts at analyzing accounts receivable to formulate effective plans of action for A/R clean-up projects
  • Highly experienced with reading, interpreting and negotiating Insurance Contracts and Fee Schedules to ensure physicians are fully paid for services provided.

Why do most medical billing companies choose not to focus on insurance A/R?

  • It is extremely time intensive and complex; very few billing companies have the knowledge and expertise available to analyze and recover the unpaid A/R. This is a major differentiator between MedXPrime Revenue Recovery and other companies.
  • A recent study by the American Medical Association found that medical practices spend almost $15,000 annually on phone calls, investigative work, and claims appeals associated with reworking claims, only to be unsuccessful in maintaining satisfactory collections. This is in addition to the millions of dollars left on the table every single year due to under-reimbursement.

Why are we so successful in collecting on old claims?

We understand the issues that cause denials:

  • Incomplete or incorrect coding, bundled services, pre-authorizations or referral not obtained, demographic errors on claims, failure to prove medical necessity, missed timely filing deadlines.
  • We have a solid understanding of corrective actions to take regardless of the denial reason given. Our team’s track record (collecting $200 million on a $360 million project) and expertise in this area are what set us apart from the competition.
  • We not only collect on old claims but the information we share tremendously helps the client in reducing denials in the future.