HOSPITALS

Hospitals of all models and sizes continue to recognize advancements in useful software and hardware resources for effective revenue cycle management. Working with MedRev adds an additional layer of back-end revenue cycle quality review. MedRev reviews open or closed AR against Hospital contracts and state and federal guidelines to uncover administrative and clinical underpayments. Our team of expert auditors have years of experience uncovering the variety of risk areas thrown at hospitals concerning everything from complex inpatient visits to routine clinic care.

Example risk areas reviewed by MedRev:

1.  Medical/Surgical Rates paid versus Cardiology/Trauma/Spine/Neurology/Computer Assisted Rates

2.  Outpatient multiple procedure denials for “incident to” that conflict with the contractual agreement

3.  Observation rate errors

4.  Inpatient vs. Outpatient reimbursement conflicts

5.  Denial overturn of medically necessary industry standard services substantiated with medical records

6.  Stop Loss Calculation Errors

7.  Lost Charge Audits

8.  Missing or mis-coded implants and/or high pharmaceutical charge errors

9.  Medicare Advantage MS-DRG reimbursement underpayments 

10.  Denied services that have mandatory coverage due to the Affordable Care Act

11.  Administrative penalties applied for unsupported inpatient admissions that were confirmed medically necessary and without contract support.

12.  Series Billing Errors

13.  Emergency Room (Medical Necessity, No Auth and EMTALA)

14. All Other

MedRev has supported hospitals nationwide and recovered over $12M in lost revenue. Please contact us to learn more about how MedRev can identify proper payment and denial management solutions for your Hospital facility.