Do You Review Your Payers for Reimbursement Contract Compliance?

As the leading revenue management company in the orthopedit industry, CrossCurrent brings a unique set of capabilities when providing our INCISIVE Audit Services (INCISIVE AS). Unlike the manual reimbursement reviews offered by consulting services, CrossCurrent is capable of reviewing a clinic's entire base of Explanation of Benefits (EOB) data against the actual payer contract terms. Our reimbursement contract engine can take years of EOB data and recalculate the exact contractually expected reimbursement amount that should have been paid according to your Payer contract. INCISIVE AS is built with one goal in mind-force Payers to live up to their reimbursement contracts.

Once completed, this analysis can also help clinic administrators understand the accuracy of their payment systems. Because the analysis is based on actual Payer contract terms, clinic administrators can quickly identify underpaying insurers, isolate specific medical procedures for better review or coding, improve administrative processes, update their fee schedules, and implement better EOB dispute policies. The result is a more efficient and profitable reimbursement process.