Payment Recovery Case Study

May 24, 2023

Case Study | May 24, 2023

Nonprofit acute care hospital partners with ElevatePFS to identify and recover lost revenue due to underpayments

For many hospitals and health systems, underpayments from government and commercial payers can significantly impact revenue recovery. According to the American Hospital Association, underpayments grew more than 32% in 2020 over the previous year, and combined underpayments just for Medicare and Medicaid added up to more than $100 billion.¹ The impact of underpayments on a hospital’s bottom line is significant and can vary greatly depending on the complexity of payer contracts and mix. Typically, underpayments can range between 2-6% of paid claims, not to mention the negative impact of inaccurate claims adjudication on patient satisfaction.² It can be beneficial for a provider to consider bringing in an experienced partner that has the reimbursement expertise and specialized technology to analyze payer contracts and identify and collect on underpaid claims.

The Challenge

A nonprofit, 425-bed, short-term acute care hospital in northwestern Arkansas that is part of the largest health system in the area had become increasingly unhappy with its payer contract management software vendor, which was not maintaining the timeliness and accuracy of its contracts, resulting in excessive underpayments. Due to inaccuracies and delays, it was unable to generate exception reports, which placed it at risk for missing timely filing deadlines. It frequently did not receive its write-down file on time and periodically went multiple days without receiving one. The hospital weighed a variety of options to improve revenue recovery and alleviate the additional burdens on its staff of customer service representatives, billers, collectors, adjustment analysts and other business office staff. As a result of this process, Elevate Patient Financial Solutions^® was selected for its ability to seamlessly integrate payment recovery services and enable 100% collections across all payers.

The Solution

ElevatePFS worked with the hospital to understand its needs and identify its priorities, which included: Accuracy of expected reimbursement; timeliness of write-down file; and good and timely customer service. Based on these requirements, ElevatePFS developed a detailed onboarding implementation plan, which included features such as a daily adjustment file that offered a greater level of accuracy than the hospital’s previous vendor. The hospital also had a wide variety of payers and extensive managed care contracts, which required additional customization prior to launch to ensure accurate payment of their claims.

“The ElevatePFS staff are very attentive and knowledgeable. Working together means our organization is on a stronger financial footing and better positioned to serve our patients.” — Hospital CEO

The Results

In the first two years, ElevatePFS optimized payer collections and delivered $36 million of revenue recovery for this client. ElevatePFS’ robust technology identified all potential underpayments and the ElevatePFS reimbursement team pursued each underpaid claim, using customized appeal letters and phone calls to effectively resolve every claim.

As an added value, ElevatePFS provided the client with root cause analysis reporting that led to an additional $3.5 million in savings and a 38% reduction in underpayments.

This combination of deep revenue cycle expertise, specialized technology, and exceptional customer service continues to
strengthen the partnership between ElevatePFS and the provider and has enabled the client to optimize their revenue recovery from all contracted payer contracts. Today, ElevatePFS remains the proud payment recovery service provider for the Arkansas-based hospital.

The Elevated Difference

ElevatePFS’ proprietary technology utilizes over 600 pre-built reimbursement calculation algorithms to analyze any type of contract and identify all collectable payment variances.

The ElevatePFS reimbursement team has decades of reimbursement experience with specialized expertise, and results are maximized by assigning claims to a specialized collector, based on payer name, contract type, size of claim and variance reasons.

ElevatePFS also helps facilities improve efficiency and workflows, by providing root cause process improvement reporting that identifies opportunities for process improvement and helps prevent future revenue leakage.