Healthcare Claims

Identification and Recovery - Contract Analysis



Systematic retrospective claims audits scrutinize all aspects of the claims process for error identification and correction. Typically, retrospective audits analyze 2 years of paid claims history and recover on average 2-5% of total claims paid. Errors found in retrospective audits often identify system-wide issues that require correction to control future errors. This can lead to cost reduction prospectively as well as cost recovery on overpaid claims.

An independent and objective assessment can be initiated from several different starting points. For example, a review of the claims-processing practices and procedures is conducted during the claims-recovery process to evaluate administrative and claims-policy compliance, assess performance standards, and identify processing issues. Our analysis can assist benefits administrators in measuring program performance and monitoring ongoing effectiveness of cost-containment initiatives and benefits changes. From the employer's perspective, a review may involve controls in the management of vendors that impact the delivery of third-party services. Finally, from the employee perspective, we also have tools to help the frontline in making decisions that ultimately will impact the initiation of claims.

Prospective Savings - Revenue Recovery Opportunity

Many healthcare providers continue to write off millions of dollars in contractual adjustments that are a direct result of third-party under-payments even when their billing, contract management and payer reimbursement audit procedures are adequate. Our team is made up of former Revenue recovery managers and analysts who know that simply because systems are operating and processes are in place does not necessarily mean that you are getting what is due to you.

We are committed to being your partner in ensuring the financial integrity of your medical claims! VBC Revenue Recovery has helped IPAs and Medical groups recover millions of otherwise lost revenue. We have a powerful track record of recovering both commercial and Medicare Transfer DRG and IME underpayments for providers across the region. VBC Revenue Recovery utilizes its proprietary software to immediately and efficiently work through the identification and follow-up tasks required to validate the accuracy of commercial and Medicare/Medicaid billing, to ensure compliance and to make final determination of various underpayments.