KREG’s Retrospective Payment Compliance
KREG’s retrospective payment compliance review is designed to identify incorrect payments clients have received from managed care payers. It is our experience that significant opportunities exist in this area due to the complexity of the contracts being negotiated today, inadequate calculation systems by the payers, and a lack of staff and resources to review the accuracy of every single payment received.
KREG’s approach is comprehensive and non-interruptive to the organization’s day-to-day operations. Your staff can continue to concentrate on their respective jobs while KREG builds and reviews a database of claim and payment information that will point out specific inaccuracies in payments. Subsequent to identifying these payment inaccuracies, KREG will complete the necessary documentation and claim resubmissions to the affected payer and follow-up on the identified claims through ultimate resolution.
In most hospitals, the number of third-party contracts continues to grow, the terms of these contracts are becoming more and more complicated, and the efforts and costs of complying with the administrative requirements to secure payment are soaring. Couple these factors with pressures to reduce FTEs and many hospitals are not in a position to allocate the necessary resources to monitor payment compliance and take the necessary steps to receive appropriate payments internally.
Many industry experts estimate hospitals are being underpaid by approximately 5-10% or more on their managed care payer contracts. Unfortunately, hospitals without proper systems, processes, and/or staff to monitor this situation can lose millions of dollars a year to underpayments. Given these facts, KREG has designed our Payment Recovery Review program to assist hospitals in their review of payment compliance of third-party contracts.
At KREG, we combine the capabilities of our state-of-the-art decision support technology with the significant experience of our in-house consultants. KREG professionals bring years of experience on both the provider and payer side and are uniquely qualified to assist your organization. We have demonstrated the ability to identify and recover significant underpayments from managed care and other third-party payers on a retrospective basis. The CMA software we utilize in this process has the capacity to compute accurate expected payments for even the most complex managed care contracts. It also produces patient specific vouchers that clearly identify amounts due from the payer. Additionally, KREG has established a turnkey process going from contract modeling and payment variance identification through documentation, rebilling and collection, thereby, minimizing the amount of time and effort required of your staff.
KREG offers a complete a risk free review and are confident we will identify significant opportunities for your organization.