As discussed in “Unlocking Missed Revenue Potential with Effective Contract Management,” underpayments represent a significant and often silent challenge to realizing healthcare revenue. The difference between the amount billed and the amount paid (expected vs. allowed) can lead to significant revenue leakage. These leakages also highlight broader operational inefficiencies including capacity constraints, skill gaps, contract misunderstandings, and ineffective collaboration between revenue cycle operations and managed care teams.
Underpayment Recovery Through Flexibility
Given the complexities in the healthcare revenue cycle, a customized approach to underpayment recovery is most effective. Each health system has its unique challenges, operational framework, and financial goals, requiring tailored underpayment recovery services to effectively address and resolve their specific underpayment issues.
Healthcare organizations should look for a partner with a spectrum of solutions that offer customizable options for targeted revenue recovery efforts designed to integrate seamlessly into their existing operational frameworks. By selecting the right option based on the current state, healthcare organizations can recoup lost revenue and gain valuable insights to prevent future underpayments.
Option 1
Managed services-Enabled Underpayment Recovery Model
Option 2
Analytics-Enabled Underpayment Recovery Model
Option 3
Full-service Underpayment Recovery Model
- Managed services targeted staffing assistance for understaffed healthcare organizations with an existing contract management tool. The model utilizes data-driven insights to drive allocation strategies for already identified underpayments to our recovery specialists.
- Analytics-enabled models leverage existing client technology to work already identified underpayments in a stratified manner and perform zero balance analyses on simple fee structures and contracts.
- Full-service models provide comprehensive assistance that includes services, contract management technology, and analytics for providers with or without a contract management tool or specialists to manage underpayments and future contract negotiations. AGS Health and FinThrive provide one such all-encompassing solution for healthcare organizations.
Advantages of a Customized Approach to Underpayments
Adopting a tailored approach enables healthcare organizations to identify revenue gaps swiftly and experience revenue recovery within a short period, often within just a few months post implementation. It also allows for a deeper analysis of trends and underlying causes, laying the groundwork for the development of effective remediation plans and mitigation strategies.
By closely collaborating with managed care teams and refining contract management processes, healthcare organizations can increase payer accountability and position themselves more favorably for future negotiations to significantly enhance revenue streams. Strategic alignment and data-driven insights enable healthcare institutions to recover lost revenue while paving the way for sustained financial growth and stability.
Check out our underpayments ROI calculator designed to help quantify the issue of underpayments and manage underpaid claims more effectively to help ensure long-term financial health.
Matthew Bridge
Ryan Chapin
