SERVICES

Our contract specialists meticulously load the payment rates and terms of healthcare providers' existing Payer Agreements into the Contract Module. Collaborating with the healthcare provider's Billing Department and claim Clearinghouse, we electronically upload ANSI ASC X12 837/835 files using our HIPPA-compliant, proprietary encryption platform. (837 and 835 files are industry standard for submitting healthcare claims and payment information electronically).

Leveraging these critical data sources, our expert team and software logic pinpoint variances in payment reimbursement and the healthcare provider's contractual agreements with Payers. The resulting data is presented in an accessible, user-friendly format. As your healthcare provider partner, we will closely collaborate with your staff to strategize and formulate a plan to recover lost revenue from underpaid, suspended, and incorrectly denied claims.

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Forensic Analysis

Contracting

Our Contract Modeler is designed to “plug and play” proposed reimbursement scenarios, rates, and contract terms using historical claim utilization data to determine revenue outcomes based on a provider’s specific case/service mix. This valuable tool allows the healthcare provider to assess the Payer’s contract proposal’s impact and identify opportunities to maximize revenue.

Our team of specialists is experienced professionals having worked in administration, operations, and contracting with major Payers. Consulting services, as well as contract negotiation services, are available.

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ANALYSIS / REPORTING

All data elements captured in the electronic 837/835 files are defined by CMS and housed in a secure client-specific environment on your HIPPA-compliant/encrypted server. Medical Revenue Optimization offers a suite of standard claim utilization reports and the ability to provide customizable, user-friendly reports.

This comprehensive capture of all data related to a healthcare service experience provides a picture of the healthcare provider’s need to evaluate current and future operations.

4

Variance Review and

Revenue Recovery Strategy

We are neither a Revenue Cycle Management firm nor a collection agency that contacts patients. Our non-disruptive and non-intrusive approach focuses on identifying overlooked revenue within the 91 days to 24 months window after billing completion, ensuring no potential revenue source is missed.

Our proven track record consistently delivers a minimum recovery rate of 5 to 30 percent of gross revenues, significantly boosting your financial standing. By integrating seamlessly with your existing processes, we provide impressive financial results without upfront costs or operational disruptions.

MedxRev is solely focused on helping healthcare providers identify and recover lost revenues, ensuring you get what you are owed from payer contracts.

2

HOW CAN MEDICAL REVENUE OPTIMIZATION HELP?

We will review every payment over the past two years to verify that they were paid in full according to the payer agreements.

Our team of experienced contract specialists will analyze, load, and verify that all contract details have been entered correctly into the platform.

Once your Electronic Claims are uploaded to the platform, we will provide the following details:

○ Any claim setup issues.

○ Breakdown of Payment shortfalls by Payer according to Claim Adjustment Reasoning.

○ Group all Payment shortfalls by collectability.

○ Begin collections on past underpaid claims.

○ Our goal is to initiate collections within ten days of receiving all relevant information

Contact Us

Get in touch with our consultants today to recover the revenue your company deserves.