Missouri Surgical Center
01. The Client
Missouri Surgical Center (the “Provider”), an ambulatory surgery center located in Missouri, is a group of specialized physicians and surgeons devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of the musculoskeletal system. For four plus decades, the Provider has delivered the finest orthopedic care to patients across Missouri and the Midwest.
02. The Сhallenge
The Provider was using a third-party agency to handle out-of-network and underpaid claims. Over time, the Provider continually struggled to capture workers’ compensation revenue from surgeries dating back to 2017. As the Provider is located in Missouri, a state with no fee schedule, payers and third-party repricing agencies were typically underpaying on the Provider’s workers’ compensation cases.
The Provider engaged Comp Recovery, Inc. (“CRI”), to perform a no-risk, no-cost analysis on cases from 2017 and 2018 to determine whether the Provider was missing out on potential workers’ compensation revenue.
- Engaged with a third-party agency with incomplete understanding of workers’ compensation payment guidelines
- Low-paying or poorly negotiated PPO contracts
- Repriced bills by silent PPO companies such as Conduent, FairPay Solutions-Mitchell, and Foresight Medical
03. CRI's Findings
CRI performed a detailed analysis of the Provider’s 2017 and 2018 cases, and determined that there were significantly underpaid workers compensation claims that needed to be appealed, such that the Provider’s lost revenue could be recovered and returned.
2017 percentage of workers' compensation cases underpaid
2018 Underpaid rates
04. CRI's Solution
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. CRI then utilized its proprietary workflow portal, “CRID”, to appeal specific underpaid 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.
To date, Comp Recovery has recovered upwards of $500k of underpayments and continues to aid in recovering lost workers compensation revenue.
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