Hospitals continue to be challenged by insurance companies that wrongfully deny and delay payment of their claims. As a result, one of the biggest questions facing hospitals today is how to best allocate resources among obtaining payment on current accounts, obtaining payment on denied accounts, and reviewing paid accounts for additional dollars.
RSource helps hospitals find the optimal balance between in-house and outsourcing efforts. The timely placement of the most problematic claims and payers to RSource allows hospitals to focus their staff on their highest-value receivables, keeping them current while ensuring that maximum reimbursement is obtained on denied, stalled, and underpaid insurance claims.
Most hospitals do not have the resources to effectively follow-up on every problem account to produce the greatest recovery. The time required to review admission documentation and medical records and draft appeals that present the most persuasive contractual and legal arguments is substantial. RSource’s attorneys, armed with specific reimbursement knowledge, devote the resources necessary to turn problem claims into timely payments. The RSource Problem Claims Program is for accounts with insurance balances greater than $1,000.
For a more comprehensive and custom approach to claim denials, RSource works with hospitals to proactively manage denied accounts by routing them pursuant to tailored protocols tied to specific denial codes. This allows the business office staff to concentrate on claim denials that are more “administrative” in nature, leaving the most complex denials for the RSource attorneys to resolve. The RSource Denials Management Program is a comprehensive solution, for all denials, regardless of balance.
Hospitals have numerous payer contracts that reimburse in varying amounts. Unfortunately, these contracts are not self-enforcing. And while many hospitals utilize contract management software to monitor payments, actually resolving underpayment issues can be time-consuming and contentious. An RSource attorney can be the needed resource, amicably working with a hospital’s payers to resolve underpaid claims and fix problems going forward.
With limited available resources, hospitals often give up on certain insurance denials after exhausting their internal and external resources. RSource provides a valuable resource by reviewing these accounts to identify underpayments and denials and then aggressively pursuing additional reimbursement.