According to most estimates, over 10% of U.S. medical claims are paid incorrectly due to discrepancies. On top of that, another 15% of medical insurance claims go unfulfilled because of segmented follow-ups. This, in turn, leads to higher costs and more governance-related issues for healthcare providers.

As experts in health insurance recovery, O2I enables you to gain focus on your bottom-line by fighting fraud, waste, and reduced fees. Armed with the expertise, tools, and resources which you require, we help to maximize recovery through our supplemental insurance collection services.

What is Health Insurance Recovery?

At O2I, HIRS or health insurance recovery services are a part of our extended suite of medical insurance services for global clients. Our HIRS system is based on a flexible model that can be customized based on every client's requirement. Our accounts receivable follow-up solutions ensure complete resolution including payer liability confirmation and collection, along with the identification of unrealized payments in the form of adjustments and contracts. Some of the most common reasons for unpaid claims which we help you recover include -

• Patient Demography Errors
• Insurance Writing Errors
• Medical Coding And Coverage-Related Issues
• Payer Processing-Related Issues
• Delays Caused By Carriers

We work with an in-house team of experienced and trained personnel who are swift to address denials and unpaid insurance amounts thereby accelerating your cash flow while reducing the total number of write-offs each quarter. This directly leads to better billing cycle management.

Our Health Insurance Recovery Services

From our experience, we have seen that health insurance recovery solutions can take on different forms, based on the exact nature of your business. By leveraging our proprietary tools, technology, and the expertise of our health insurance recovery service providing company experts, we help to reduce costs and increase the volume of recoveries. Our health insurance recovery services include -

1. Medical Subrogation Recovery Services

   

   As your health insurance recovery service provider, we leverage our technology and experience to recover unpaid amounts for our clients. Our in-depth investigation process recognizes potential sources of recovery including -

   • Motor vehicle accident liabilities
   • Product and equipment-related liabilities
   • Location and premises liabilities
   • Medical malpractice liabilities

   Once identified, we work closely with your legal staff to assert your rights and achieve the best possible settlement.

2. Overpayment Recovery Services

   

   We help to find out all overpayment-related issues plaguing your service and help to reduce payment leakage for better client satisfaction. We aim to identify and recover all the benefits paid where either Medicare or any other payer should have paid the primary amount. This information is then shared with you to ensure accurate payments can then be made.

3. Accurate Reporting

   

   One of the primary challenges for health plans which directly feed medical information to Medicare is to look beyond Section 111 compliance. At O2I, we ensure we provide the correct entitlement data to directly reduce Medicare's or any other provider's potential for overpayment thereby boosting the risk involved for you. We offer -

   • Timely and accurate determinations
   • Regular updates to a common working file
   • Maintenance of medical primacy records
   • Accurate MSP and non-MSP reporting

4. Secondary Payer Validation

   

   When you are outsourcing healthcare recovery services, you need a partner who can go through your list of Medicare Advantage payers and check for other commercial insurance coverage. This is because it allows you to validate the data and ensure the primary payer is listed correctly. This directly ensures you can receive accurate and higher premiums if the health plan is the primary payer.

5. Pharmacy Audits and Compliance

   

   We offer an extremely flexible and scalable pharmacy auditing service which is of exceptional use to our clients. We leverage our in-depth data analytics functions to score pharmacies and perform prescription claim reviews to identify where the losses are being generated from. We help to mitigate risk, and include -

   • Retail pharmacy audits
   • Pharmacy claim check
   • LTC-related audits
   • Mail-order drug audits
   • Invoice audits
   • FWA audits
   • Drug audits
   • Pre and post network credentialing audits

6. Specialty Medical Audits

   

   We are one of the few healthcare recovery services in India that cover specialty requirements such as durable medical equipment audits, home infusion therapy audits, high-cost drug audits, etc. Our auditing process has been fine-tuned over the ages and leverages our proprietary software to focus on compliance and overpayment drivers within these areas.

7. Dependent Eligibility Audits

   

   Over the years, we have seen that many health plans carry ineligible dependents who directly increase the cost of care. Our experienced team audits multiple groups such as fulltime students, domestic partners, common-law spouses, adoptions, and other potentially ineligible dependents - to validate membership through school records, birth certificates, and other forms of identification. Then we help you remove ineligible dependents from your membership rolls and recover any paid claims on your behalf.

8. Medical Credit Balance Audits

   

   As part of our health insurance recovery services, we can recover duplicate claim overpayments, payments that are outside of the stipulated contracts, and other COB errors. We ensure all credit balances are recovered on time so as to ensure better cash flow.

Other Services You May Benefit From

Why Outsource Health Insurance Recovery Services to O2I?

Collecting back insurance claims and payments for hospitals can be extremely challenging. The amount of effort required to be put in, coupled with the resources required to collect said payments are extremely costly. Add to this the fact that each state has its regulations that need to be kept in mind, along with federal regulations. As a result, O2I offers exceptional clarity when it comes to HIRS, allowing you to benefit from the following -

• Exceptional Quality of Services

  As an ISO-certified company, we take the overall quality of our services extremely seriously. All HIRS communication with patients is logged and records are kept of all transactions occurring so as to ensure complete peace of mind.

• Enhanced Security

  With the amount of expenditure we have done over the past decade on formalizing our high-quality infrastructure, you can rest assured about the security of your data and the overall confidentiality of the process. All our confidentiality measures are up to international and US standards.

• Flexible Model

  We offer a flexible and very scalable model that includes the ability to work directly with multiple hospital systems while ensuring internal protocol is never broken. The ability to easily adjust our resources based on your needs while decreasing or increasing supplemental staff is exceptionally helpful during lean periods, not to forget, the flexible pricing options.

• Experienced Staff

  Our employees are US healthcare receivable specialists who have worked in this field for more than 5 years, ensuring all our healthcare insurance recovery services provide you with the best value for money when it comes to experience and handling majority US carriers.

• Remote Follow-up

  Our team of agents directly get in touch with the targeted patients or Medicare agents through a secure accounting system for secure, efficient, and consistent returns.

• Complete Integration

  All our health insurance recovery follow-ups can directly sync with other CBS programs including custom patient billing software, etc. This ensures that all amounts which a patient or insurance service provider owns can be identified in single follow-ups, are immediately billed, and then collected.

• Easy Software Integration

  Over the years we have worked with multiple patient accounting systems such as Meditech, Invision, STAR, Paragon systems, etc. along with many support systems such as Artiva and Medicare FISS. This ensures we can work with multiple accounting systems so as to speed up the process of health insurance recovery.

• Extension of Similar Functions

  One of the hallmarks of our healthcare recovery services in India is the way we directly begin functioning as an extension of our teams in the way the services are delivered. We understand your reference material and keep an in-depth record of all facility lists, NPIs, PTANs, PINs, Payer code lists, claim forms, reference guides, etc.

• Dedicated Project Managers

  We understand how important it is for you to understand the nature of progress in the project as well as the technicalities involved at multiple points. For the same, we assign a dedicated project manager to work with you on the project, serving as the SPOC for all your needs and requirements.

• Customizable Reporting

  With the help of new-age dashboard and custom reporting features, we are one of the few healthcare insurance recovery service providers out there who can help you achieve the streamlined processes you want to implement within record time. Our services provide you with estimates such as -

  • Daily/weekly/monthly reports
  • Number of units worked upon
  • Detailed accounting history
  • Amount resolved
  • Cost estimates

Client Success Stories

Partner with Outsource2india for High-quality Health Insurance Recovery Solutions

Healthcare providers in the US and elsewhere routinely lose revenue that is then required to be written off as contractual misadjustments. This happens when third-party payers end up underpaying due to numerous differences in coding or account-related issues. We specialize in identifying and correcting the said underpayments, improving your bottom-line while also resulting in enhanced patient satisfaction.

Our holistic approach towards HIRS ensures the root cause of underpayments is recognized and changed so as to ensure mistakes never happen. To know more about how our medical insurance services can help you significantly improve overall performance and AR functions, contact us now!