Frequently Asked Questions

Insurance Discovery

  • Insurance Discovery is the process of identifying active billable insurance coverage for patients who initially present as self-pay or uninsured. This ensures that healthcare providers can bill the appropriate insurers, reducing uncompensated care.

  • It helps providers recover revenue that might otherwise be lost due to unbilled insurance claims, thereby decreasing bad debt and enhancing financial stability.

  • The process involves searching multiple payers to find hidden or unreported insurance coverage through comprehensive checks, often utilizing advanced algorithms and data analytics.

  • Ideally, it should be conducted at various points: during scheduling, pre-registration, registration, and post-discharge, to ensure no coverage is missed.

  • Insurance Discovery can uncover various types of coverage, including commercial insurance, Medicare, Medicaid, and exchange plan coverage.

  • No, reputable Insurance Discovery processes comply with all patient privacy laws and regulations, ensuring that patient information is handled securely.

  • Advanced Insurance Discovery tools can provide results within days after data submission, allowing for timely billing and revenue recovery.

  • Yes, providers can significantly reduce uncompensated care costs by identifying billable insurance coverage, making it a cost-effective solution.

  • Many Insurance Discovery solutions are designed to integrate seamlessly with existing hospital billing and patient management systems.

  • Even with an existing vendor, iMedTech’s solutions can uncover an average of 18% more billable insurance opportunities, ensuring you maximize your revenue recovery potential.

Medicare Underpayment Recovery

  • It is the process of identifying and recovering funds that Medicare underpaid to healthcare providers, ensuring full reimbursement for services rendered.

  • Underpayments can result from incorrect claim coding, missed retrospective reviews, or improper application of Medicare policies.

  • Through comprehensive audits of Medicare claims, often utilizing proprietary technology to detect discrepancies between billed services and received payments.

  • The PACT policy involves inpatient claims reimbursed on a per diem rate up to the full Medicare Severity Diagnosis Related Group (MS-DRG) code reimbursement.

  • The RAC program identifies improper payments, including underpayments, by reviewing past Medicare Fee-for-Service claim data.

  • Providers should submit corrected claims or adjustment requests to Medicare to recover the underpaid amounts.

  • Yes, Medicare imposes specific time frames for providers to submit claims adjustments to recover underpayments.

  • Yes, advanced technologies can automate the review process, increasing accuracy in identifying underpayments and expediting recovery.

  • Adhering to security and compliance standards ensures that the recovery process aligns with Medicare regulations and protects patient information.

  • Implementing thorough claim review processes, regularly training staff, and utilizing technology to ensure accurate coding can help prevent underpayments.