Hospital Insurance Revenue Recovery

Written by Kimberly Clark
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No other industry has to contend with the frequency of delayed or denied payment for the services rendered, as does the healthcare industry. In the majority of these cases, the health plans or insurance providers responsible for paying the claim wrongfully denied the claims. The process of obtaining financial reimbursements from healthcare payers who have wrongfully denied a hospital's healthcare claim is often referred to as hospital insurance revenue recovery.

Generally, when a patient visits the emergency room or is admitted into the hospital, they are treated first and then a claim is sent to their healthcare payers. Sometimes the patient is required to pay a co-payment or deductible prior to receiving services. More often than not, the healthcare provider is placed in the subjugated position of waiting for the payer to approve payment for the majority of the balance.

The process of pursuing denied or unpaid healthcare claims can become quite a burdensome task. Plus, most in-house billing departments are simply not equipped or adequately staffed to handle the massive workload of pursuing appeals. So instead of bogging their administrative staff down with the tedious job, many hospitals decide to outsource their revenue recovery to firms that specialize in obtaining these funds.

How Revenue Recovery Firms Help

Contracting to a revenue recovery firm not only saves the hospital time, but it can also save them money because many of the firms have a "No Recovery / No Pay" policy. This means the hospitals pay a percentage of the total denied claim to the firm only if the firm is able to collect on it. In addition, revenue recovery firms are usually staffed with arbitration and litigation experts that understand the inner workings of the healthcare claims system.

One key step in the process is to avoid these situations altogether. A system should be in place, whether utilizing hardware or software (software is usually the less expensive alternative), to determine eligibility more quickly. There are a number of ways to do this, and whether is system is automated or done by batch, checking eligibility before performing services can save time and money almost immediately.


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