Medicare and Medicaid are not the only payers when hospitals and physicians get reimbursed for their services. Many insurance companies grapple with consumers about the extent of their coverage. Legislation available on the state and federal level address the solvency of various insurance companies as well as the need to inform consumers of their best possible options and what their eligibility for different programs.
RACs involve strictly the denial or recovery of federally provided reimbursements. Many health care institutions may find it better to diversify their payer mix. We are able to micromanage by analyzing from a business analytical standpoint the numbers from the hospital, single, or group practice. Whether it be DRGs, the number of beds in a hospital, the demographics of the population, and the reliability of various insurance companies, we evaluate every dollar and every sheet. We make sure we are meticulous in putting the information together in helping our clients understand that they are not just practicing a skill, but running a business.