Medical center identifies over $4 million in underpayments by optimizing payment accuracy
Discover how Baker Tilly addressed significant reimbursement discrepancies for a hospital by analyzing billing processes and recovered millions in underpayments
Client background
A 200+ bed not-for-profit medical center in the mid-west that offers a range of services to patients and has a wide variety of insurance payers.
The business challenge
The organization faced discrepancies in reimbursement rates from various insurance payers. They noticed that certain payers were not fully reimbursing them for the services rendered, leading to potential financial losses. To address the issue, they engaged Baker Tilly to optimize their reimbursement rates, prompting a thorough analysis of their reimbursement rates in comparison to their contracted rates with payers to identify discrepancies and recover underpaid amounts.
Strategy and solution
Baker Tilly played a crucial role in identifying underpayments and preventing financial loss for the organization. We conducted a thorough analysis of existing reimbursement claims in bulk, identifying key underpayment areas and discrepancies among the various payers.
Throughout the assessment, our team met with the organization’s management team members monthly, breaking down each payer’s contracted rates versus actual reimbursement rates. Leveraging Power BI, we created visual representations of the reimbursement data to highlight underpayments. Additionally, by utilizing proprietary data integration tools, Baker Tilly consolidated remittance information and the hospitals contracts, ensuring seamless access to current information for precise analysis and reporting. By conducting a thorough review of the reimbursement process, Baker Tilly completed the following:
- Analyzed tens of thousands of claims across 20 payers and plans
- Identified underpayments impacting the business
- Gained a comprehensive understanding of the reimbursement issues
- Identified over $4.7 million in underpayments for the organization
- Developed flags to ensure accurate payments after notifying the payer
Baker Tilly worked with the hospital over a 12-month timeframe to identify underpayments and ensure appropriate payment, improving the organization's financial success and enabling them to continue securing the correct reimbursements rendered.