Managed Care Review

managed care review

The complex reimbursement methodologies of Managed Care and Medicaid make it very difficult for information management systems and patient accounting team members to determine if payments are correct. All too frequently, payments are accepted that are well below the correct amount. Our specialized team of experts review paid claims to determine if additional recovery is possible. If necessary, we rebill, follow up, and appeal claims until appropriate payment is received. In addition to recovering additional revenue, our Patient Account Specialists and Clinical Audit Teams utilize the evaluation of specific claim details to identify trends and issues causing underpayments so that these systematic problems can be resolved and future claims paid correctly.

Our post-payment recovery audit finds and recovers what clients miss.

Often overlooked components that can lead to underpayments include:

  • Contract terms that adversely affect cash
  • Software solutions content management
  • Internal processes that bypass reimbursement discrepancies
  • Administrative and technical processes that reduce cash
  • Compliance issues that increase risk
  • Revenue integrity concerns

An effective post-payment recovery program keeps payers accountable and identifies trends that affect reimbursements on a go-forward basis.

Our intricately-organized teams of clinical and financial professionals prepare billing documents for deserved additional revenue and aggressively follow-up with payers to ensure accurate revenue is recovered.

Adreima is pleased to announce that it has been acquired by nThrive. nThrive is a growing industry leader that leverages technology, services, education and analytics to create complete Patient-to-Payment℠ capabilities that our clients need.

Please view our press release for additional information about this exciting acquisition.