Zero Balance Audit & Recovery
The American Medical Association reports that commercial health insurers experienced claim-processing error rates as high as 20 percent in recent years. This is due in large part to complex benefit plan design; varying eligibility and authorization requirements; different in-network and out-of-network coverage, payment rates, and deductibles; benefit restrictions, carve-outs, medical necessity interpretation and more.
Outright claim denials are easy to spot and therefore get responded to in most cases. Underpaid claims, however, are much more difficult to identify and over time can add up to millions of dollars of lost revenue. Given the proliferation of claim payment errors, it's surprising how many hospitals and health systems still don't routinely audit paid (zero balance) claims for underpayment.
Titan Health has specialized in zero balance audits and revenue recovery since 2002. Our experienced auditors use our state-of-the-art METIS™ analytics software to identify underpayment trends and highlight suspicious claims. We then analyze these claims to determine if they were processed in accordance with contract terms, if all services rendered were captured and coded correctly, and if any revenue opportunities were missed.
Best of all, any cash collected from reprocessing these claims goes straight to your bottom line. We also provide detailed explanations of the root causes of any underpayments we find and make recommendations on how to avoid them in the future. Since our ZBA fees are contingent on the amount of revenue we recover on closed accounts, there is no risk to your organization if we fail to collect.
Call today to schedule your risk-free, no obligation consultation with a Titan Revenue Recovery Professional.