Frequently Asked Questions

 
 

Q: What will it take to begin the process?
A: Our process to recover revenue through the Prompt Pay Recovery program begins at the first in-person meeting. At this meeting, we will coordinate the data collection and begin the CIRCA℠ Process. We produce the needed assessment reports for you to decide the best revenue pursuit strategy using your Business Contracts and the Prompt Pay allowances per your state. We use your electronic 835/837 claims communications for accurate reporting.
Med-Enterprise will obtain the following items from each client in order to assess the relevant billing data for Prompt Pay and

Business Contract violations:

  • Billing System Data

  • Revenue Data

  • Data Access Information and Authorization

  • PayerPayor/Client Contracts

See Services>Prompt Pay Recovery for more details

Q: How much is this going to cost me?
A: The entire process is contingent. We will collect, analyze using our CIRCASM process and bring the entire process to resolution with no out-of-pocket expenses to your organization. Our fees will be agreed upon in our initial conversations.

Q: Why should I hire you? Are there easier ways to do this?
A: We are consultants with a successful track record, differentiating us from other prompt pay analytics. We provide accurate damage models. Additionally, we provide added value reports for your revenue cycle operations and managed care contract negotiations, which is all part of our standard client consultative services. 

Q: What kind of recovery can I expect?
A: Each medical provider's potential recovery will vary depending on the size of the facility. In the case of a physician group, the measurement is based on the number of physicians and their specialty. In the case of hospital systems, the number of beds determines size. A factor in determining the potential recovery is the percentage of Medicare/Medicaid billings versus in-network commercial billings. 
Med-Enterprise offers a FREE Prompt Pay Recovery Proof of Concept. Your state must have a progressive Prompt Pay Statute that allows for a retrospective look back into payer’spayor’s claims. Upon completion you will receive and review a summary report that outlines the potential Prompt Pay recovery levels available for your organization. Terms and Conditions apply.

Q: What is the average time that it will take to resolve my claim?
A: After completion of a thorough analysis, the process generally takes anywhere between 12 and 15 months from start to finish. This process incorporates a series of validations and adjustments to the program so as to capitalize on the accuracy of the data.

Q: Doesn’t my revenue cycle department handle this?
A: Revenue integrity is on the minds of most revenue cycle departments. What Med-Enterprise brings to the table is the ability to identify and address discrepancies in the payer’s billing retrospectively, sometimes as far back as four years, if the client has the data properly archived.

Q: How much of my staff’s time will be required?
A: We use minimal staff time if you have 837/835 data available. In some cases as little as a couple of hours of your time in the initial stages. From there, we will look to your staff for help in validating some of the claims, preparing to make the reports more accurate and therefore more productive in resolution conversations with the payers.

Q: What about HIPAA? Is your staff certified?
A: Your patient's HIPAA data is protected. At Med-Enterprise, all patient information viewing staff are trained and certified in the management of this information