Retrospective Review & Denial Management Services
In some settings, regardless of PFS efforts, underpayments occur. The industry norm is that 4-5%
of managed care net revenues are underpaid. QHR has partnered with a group to address this
issue via our SSP program. They are willing to work with all QHR facilities on a contingency
basis, regardless of size, and offer very competitive terms. In addition, they will support the facility
in its denial management processes should the hospital elect to engage them.
■ The SSP partner can be chosen by the QHR
facility to perform a retrospective review and associated
collections processes. The relationship and expected
payments to the SSP are strictly contingent with
the SSP partner sharing the collected monies with the
facility. In addition, all recovered monies are remitted
directly to the hospital.
■ The SSP will provide reports that provide insight
to payor irregularities, prompt pay nonconformance,
and denial activities by type that can support process
improvements at the hospital level.
■ The hospital may elect to use the SSP as an
alternative to implementing a contract management
system, or as an augment to the existing activities
and monies recovered through such tracking systems. | ■ Continued use of the SSP can serve as
a validation of the effectiveness of the identification
and collection efforts of PFS staff. It can identify
process improvement opportunities, and specific
payor problems that require attention.
■ Should a facility so elect, they can engage the
SSP on an ongoing basis to address denials much
earlier in the process at a more attractive contingency
fee. This approach tends to have a much higher recovery
rate as well. |
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105 Continental Place | Brentwood TN 37027 | 1-800-233-1470 | | | | |  |
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