Managed Care Recovery

Managed Care Recovery Picture

Are you leaving significant sums uncollected?  Do you have less than three people working in the area of managed care payment discrepancies?  Are your logs not promptly updated when discrepancies are validated?  If so, then your facility is a good candidate for ARx’s Managed Care Recovery service.

ARx has developed an internal system that is designed to review all zero balance accounts (from primary payers) for payment discrepancies. When discrepancies are identified, our team of specialists then analyze these accounts to first verify the discrepancy and validate the cause, and then to follow up with the payers for recovery and resolution. The ideal client for the Managed Care Recovery service typically fits one of the following situations:

  • High Managed Care Volume
  • Complex acute care contracts, including carve-outs, multi-tiered procedure rates, implants, etc.
  • Frequent rate changes or updates are overlooked and don’t make it into the model, or are modeled incorrectly

The table below is a representation of the standard ARx Discrepancy Project workflow process:

managed care recovery service slide 110409d

In addition to the financial benefits related to recovered revenue, the hospital also benefits from the wealth of information, documentation and other feedback provided by ARx as part of the standard Managed Care Recovery service. This information assists the hospital in future contract negotiations with their payers. Below are two examples of the standard ARx Reimbursement Worksheet, which indicate the type of reporting that ARx makes available to our clients:

Example 1

Example 1

 

Example 2

Example 2