Hospitals, clinics and other health care providers can no longer afford to write off denied or short-paid insurance claims no matter how large or small they may be. And they no longer have to employ dozens of business office insurance clerks!
Envision a business office where every payment is automatically audited using the CostFlex automated health insurance contract (described in another section). Of the thousands of payments received each week, only those which were denied or short-paid are presented to the insurance clerk.
Each entry presented to the clerk prints (displays) the hospital’s “EOB” listing the page and paragraph from the healthcare contract that controls the reimbursement for that patient.
Armed with this data, the hospital’s billing/insurance clerk becomes formidable. He or she is no longer just a high school graduate battling the seemingly more powerful insurance company clerks with their typical and costly “delay, deny, defend” approach to negotiating payment disputes.
The success of this CostFlex module is impressive if not phenomenal. One CostFlex client – a five hospital system - has consistently proven to their payers the futility and cost of losing every dispute.
Now, this hospital system just sends an Excel spread sheet listing disputed payments and gets paid. They routinely post over $2 million of recoveries to the bottom line each year.