Denial Management

Denial Management

Benefit Recovery has been providing excellent service to Memorial Hermann as a Third Party and Denial vendor. Prior to this engagement, we had two other agencies performing the same function and Benefit Recovery consistently stays in the top tier when it comes to performance and customer service. I highly recommend Benefit Recovery, and I am quite sure they will provide the same level of satisfaction for your hospital as well.
MICHAEL C. BENNETT
System Executive, Operations Finance/Patient Business Services , MEMORIAL HERMANN HEALTHCARE SYSTEM

Tough and Getting Tougher

Carrier contracts and procedures have become extremely complex. Throw in the requirements of the ACA, and you now need people with years of experience using very sophisticated tools to successfully follow up on and appeal a majority of claims that have been formally denied by a carrier. Yes, you can build some of that capability in-house, but dealing with the countless barriers that carriers construct to keep you from getting the money you are owed is not your core business. That’s why many providers outsource at least a part of that job. But who do you outsource to? What should you look for in a supplier?

Experience

Experience is absolutely essential, and it’s one of the reasons Benefit Recovery is so highly recommended. In fact, our denial management specialists have an average of 14 years experience. Contact us to learn just how comprehensive that experience is.

Persistent Follow-Up

It can take a lot of calls to successfully resolve a claim. That’s why our proprietary systems and workflow process guarantee persistent follow-up. Our systems contain alert features that ensure all claims are worked in a timely manner, with every carrier contact thoroughly documented and every account meticulously audited to verify accuracy. Talk to us for a complete overview of our systems and procedures.

Information Gathering

Information is key to denial management.  Benefit Recovery takes the time required to gather all relevant data, including patient medical records, UR clinical notes, pre-authorization or insurance verification, referral information from primary care or other treating physicians, and much more. Contact us to learn more about the information we compile before working the account.

Appeals

When a carrier insists on upholding its denial decision, Benefit Recovery continues to explore every level of appeal available.  Most facilities and revenue recovery vendors give up prior to reaching the highest levels, but Benefit Recovery keeps going until you receive the money you are owed. Contact us  for details on our tenacity.

Legal and Pre-Legal

You’ll get better results if you do not use an attorney unless and until all other procedures and possibilities have been exhausted. When that happens, Benefit Recovery is equipped to provide legal action, but this is always done on a case-by-case basis with client approval only. Talk to us for a more in-depth discussion on when to use a lawyer.

Payer-Specific Solutions

Each carrier is different – sometimes quite different – and their policies and procedures can even differ from state to state or region to region. Benefit Recovery has extensive experience working with all payers. Talk to us to learn more about our experience with specific payers.

Collaboration

Maybe you don’t need full service revenue recovery. If that’s true, Benefit Recovery can focus on small balance and other claims that your staff cannot or has not been successful in processing. We can also review larger balance claims when all efforts are exhausted by your staff.  It doesn’t cost you anything to have us take another look at a claim that might otherwise be abandoned. Contact us to learn about our success rates.

Request one of our e-Brochures today.
Talk to a sales representative

Contact Sales