Financial recovery groups offer a range of revenue cycle management services to hospitals and health systems. These can include insurance verification, medical billing, denial management, and clinical documentation improvement. The overarching goal is to help hospitals capture more appropriate reimbursement for services provided. With constantly changing payer policies and an increase in high-deductible health plans, getting fully and quickly paid for services is becoming more complex. Financial recovery groups bring specialized expertise to navigate these challenges.
Increasing Collections with Insurance Verification and Medical Billing
One key service financial recovery groups is verifying patients’ insurance coverage upfront and handling medical billing and collections afterward. This helps hospitals capture more owed revenue. Financial recovery groups have teams dedicated solely to verifying eligibility and patient benefits. They also have billers specialized in submitting and following up on claims with private insurers, Medicare, and Medicaid. Their expertise and persistence in appealing denied claims enable hospitals to collect on more accounts that they may have otherwise written off.
Optimizing Reimbursement and Denial Management
Insurance claim denials are a major source of lost revenue for hospitals. Financial recovery groups can significantly improve denial management through data analysis, payer policy expertise, and skilled staffing. By tracking denial rates and reasons, financial recovery groups identify problem areas and work to correct them. Their dedicated denial specialists are trained to appeal a high percentage of denials successfully. This reduces write-offs and brings in more reimbursed revenue for completed hospital services.
Driving Revenue Through Clinical Documentation Improvement
Accurate and thorough clinical documentation is essential for maximizing reimbursement, yet many hospital physicians lack the time and training to optimize it. Financial recovery groups have clinical documentation specialists who analyze medical record documentation and educate physicians on proper coding and reporting. This improves the accuracy and specificity of diagnosis and procedure documentation. In turn, more claims meet requirements for higher-level billing codes and medical necessity justification. This directly translates to increased revenues for hospitals.
The Revenue Results: Millions in Recovered Revenue
When hospitals partner with financial recovery groups, the results are often substantial in terms of increased revenues. Many hospitals report double-digit percentage increases in net revenues within the first year. For larger hospitals, this can equal tens of millions of dollars in recovered payments. Smaller community hospitals also see millions gained by partnering with financial recovery groups.
With the rising gap between billed services and reimbursed payments, these revenue recovery gains are critical for hospitals’ financial sustainability. Financial recovery groups can optimize revenue cycle management and minimize lost reimbursements in a way most hospital business offices cannot on their own. While the exact financial impact varies, the data clearly shows significant bottom line benefits for hospitals partnering with experts in denial management, insurance billing processes, and clinical documentation improvement.
The Benefits of Working with Specialist Providers
Specialist providers like FRG work within claims audit and recovery and specialize in overpayment recovery, audit services, with the provision of essential financial reporting tools like AccuReports.
Financial recovery groups offer hospitals expertise and human resources to maximize payments from patient services. Through insurance verification, improved medical billing procedures, denial management, and clinical documentation optimization, hospitals can capture millions more in owed reimbursements annually. As healthcare economics grow more complex, the services of financial recovery groups provide an essential solution for boosting hospital revenue and maintaining positive bottom lines.
