Revenue Review Solutions — RevComply™

RevComply is a review of closed-balance accounts for our hospital clients.

Most hospitals operate within a 1%-2% error rate for underpaid claims; however, 1%-2% error on annual gross charges can become significant leakage. Therefore, through our audit system, IRM’s experts can help find and collect additional amounts for your facility.

RevComply Review Summary

IRM’s internal team adds a layer of quality payment review for all closed-balance claims with discharge dates within the past year. IRM runs the accounts through a series of queries to compare the actual reimbursement to the expected contractual allowable, which identifies potentially underpaid cases. Once variances are found, the IRM team conducts the following research, review, and assessment of each variance claim.

What are the costs to clients?

• Front-end cost includes administrative support with IT system access and ongoing support for any clinical document requests, such as medical records and explanations of benefit.
• 27% contingent fee for any collected revenue from the closed AR RevComply review.

What are the client benefits?

• Increased revenue between $250-$1M in additional annual revenue from closed AR
• A summary detailing what the areas of risk were and how to avoid them moving forward; this provides ongoing process improvement-based revenue.

How does RevComply work?

The RevComply review steps are as follows:

• Confirm appropriate insurance, contract, payor details, and any ad hoc agreements to verify the appropriate discount from the billed charges.
• Receive requested data to review all closed-balance accounts.
• Create potential underpayment list for research and review.
• Review the necessary documents to confirm lost revenues (i.e. System notes, Explanation of Benefits, Operating Reports, UB-04, and/or Itemized Bill detail, etc).
  • In order to research and review, IRM will need remote access to systems, which must include the ability to print UB-04, itemized bill, and coding summary.
  • IRM must have a point-of-contact in order to request implant and drug invoices, when applicable, as well as medical records, unless these documents can be received via remote access.
• When an underpayment is confirmed, IRM will appeal the claim with all necessary, supporting documents.
• All IRM underpayments must be flagged on the hospital patient accounting system so that the facility employees know that IRM is actively pursuing additional payment.
• IRM will conduct follow-up on all appealed revenue disputes until reimbursement is received.
• On a weekly basis, IRM will receive a payment posting report from the hospital for any IRM claims that received additional payment.
• On a monthly basis, IRM will invoice facility for contingent amount. The invoice will include line-by-line account collections with a bottom line roll-up of the contingency amount. IRM will also invoice for pass-through costs, such as travel.

During and concluding our review, IRM will prepare the following:

• Analysis of audit findings and identity of trends and patterns that may indicate opportunities for process/performance improvement. IRM will provide a lost revenue list of all confirmed underpaid cases. In addition, we will track and aggregate any recurring areas in which underpayments occurred and will provide suggestions as to how to stop the underpayment trend moving forward.
• Presentation of summary reports to educate the hospital staff. These reports will identify impacted, vulnerable areas. Many times, risk occurs due to trended errors in coding, charge capture, billing, and/or documentation practices. The report will also summarize recommendations for changes to current systems and/or implementation of new procedures.

Additional Project Scope and Document Request

In order to develop a project plan, IRM will require the following items from the hospital:

1. Data Download — Inpatient and Outpatient Closed-Balance Reports (full report specs will be provided to hospital IT personnel)
   1. All patient demographics
   2. Insurance Transaction Report (insurance carrier, codes, total payments)
   3. Contract Mapping details
   4. Clinical Details
      1. MS-DRG (when applicable)
      2. Revenue Code 274-279, 636 aggregate charges by revenue code
      3. First 10 ICD-9-CM procedure codes
   5. HCPCS/CPT Details
   6. Vertical file of all patient-specific HCPCS, charges codes, etc
   7. Charge Master file
2. Remote Access to Systems
   1. Patient accounting system access
   2. Online scanning systems – EOB, correspondence, implant, and drug invoices
   3. Access to and printing ability of Itemized Bill and UB-04

Please contact IRM at info@irminconline.com for more information.