The Delphi Advisors
What is Medical Underpayment Recovery?
Simply put, the largest medical insurance payers are shockingly creative in finding ways and means to pay doctor’s offices, urgent care facilities, surgery centers, hospitals, and the like far less than what they are owed.
While everyone else is content to collect what they can and move on – We focuse on those payments received, audit them, and returns to the payor to recapture the difference between what was paid and what should have been.
Our proprietary technology identifies and recovers underpayments, manages denials, overpayment fines, and responses, automates appeals and requests, and is a contract modeler in negotiating more favorable contracts. This exclusive system also enables medical providers to recover past underpayments going back to the last 12 months of zero balance claims (those recognized as paid).
Our clients see, on average, 10 – 20% in revenue recapture (increase) through payor underpayment recoveries, as well as another 6 – 8% increase in underpaid Medicare payments (these are found dollars after claims have been fully processed, checked, and rechecked by all facility resources such as EMR, billing systems, clearinghouses and classified as zero balance).
What we help solve
- Medical providers in the United States are losing over $125 billion yearly due to underpaid and improperly denied insurance claims.
- The largest medical payers are shockingly creative in finding ways and means to pay doctor’s offices, urgent care facilities, surgery centers, hospitals, and the like far less than what they are owed.
Our no upfront cost Analysis and Solution
- ADHC Underpayment System Analysis Audit is a proprietary technology system that identifies and recovers underpayments, manages denials and overpayment fines and responses, automates appeals and requests, and is a contract modeler essential in negotiating more favorable contracts.
Case Studies
We have tested our software by analyzing hundreds of millions in billed claims. These claims were a collection of dead files, non-payments and underpayments. We found that a range of 10%-29% of claims are paid incorrectly.
Small Rural Hospital in Texas
This small hospital collected less than $19,000,000 in the last year (BCBS only). Once they started working with us, we found and collected on $4,048,555.44 in underpaid claims for BCBS Only!
Large Hospital Group in PA
When working with a large hospital group, we identified and collected on their 4th largest payor, Aetna, of over $1,200,000 which represented 18% of their collections for the payor. Additionally, we also identified another $895,000 per year in potential revenue due to allowed charge master adjustments.
Hospital in St. Louis
We identified over $10,000,000/year in Medicare/Medicaid for unpaid and underpaid claims for this hospital.