Arizona Health System
01. The Client
A health system in Arizona with four locations (the “Provider”).
02. The Сhallenge
The Provider was using a third-party agency to handle out-of-network and underpaid workers’ compensation claims. Over time, the Provider continually struggled to capture workers’ compensation revenue from surgeries dating back to 2017. As the Provider is located in Arizona, a state with no workers’ compensation medical fee schedule, payers and third-party repricing agencies were typically underpaying on the Provider’s workers’ compensation cases. At the beginning of the COVID-19 pandemic, Comp Recovery, Inc. (“CRI”) was engaged to perform a no-risk, no-cost analysis of the Provider’s cases from 2017 through 2020 to determine whether the Provider was missing out on potential workers’ compensation revenue.
03. CRI's Findings
As a leading provider of strategic revenue recovery, CRI examined the Provider’s financials to determine why the Provider’s workers’ compensation reimbursements were so low. CRI first identified the causes of low reimbursements for workers’ compensation cases, particularly those involving surgery.
2017 reimbursement rates
2017-2018 Cumulative Rates
2017-2019 Cumulative Rates
2017-2020 Cumulative Rates
04. CRI's Solution
CRI then utilized its proprietary workflow portal, “CRID”, to appeal specific claims that had initially received low reimbursements. Using CRID, CRI methodically corrected back-billings and procured additional payments on underpaid accounts. Through this process, CRI uncovered other issues that were leading to low initial underpayments on current billings.
05. Success
Through the utilization of CRI’s customizable workers’ compensation solutions, the Provider improved its reimbursement rates as a percentage of billed charges, which were initially in the low to mid-twenties, to fifty-two percent (52%) of billed charges. The Provider has also benefited from a change in payer behavior with respect to newly submitted claims, netting the Provider $19M.
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