A physician-owned hospital started with a Legacy AR review for the past 12 months of their processed claims. Collect Rx identified 165 underpaid out-of-network cases to appeal. Out of these cases, 104 of them were successfully appealed, and over $1.4M recovered!
A Behavioral Health Group with multiple locations and a combination of in and out-of-network claims, has a billing company to assist with claims management. Being out-of-network, the facility receives a large amount of upfront negotiation requests that fall outside the billing company’s standard process. Working alongside the billing company, Collect Rx was able to negotiate these requests, and helped generate over $3.9M in collections.
A multi-location Emergency Medicine organization employs an in-house billing department. Working seamlessly alongside them, Collect Rx identified and appealed underpaid out-of-network claims. Within six months, Collect Rx helped this organization recover over $5M.
In late 2019 the largest Hospital system in Texas discovered it was being forced out-of-network by United Healthcare. UHC claimed that the rates the hospital was charging and the reimbursements were too high. They also claimed the hospital was being unreasonable, and a detrimental PR fiasco ensued.
Collect Rx approached an ASC that thought it was maximizing their out-of-network collections. They had an experienced and
knowledgeable billing and collections team so they were not interested in using Collect Rx. However, Collect Rx convinced them to try our no risk approach, and deployed our 12-month
legacy CRXI Select review of their processed cases to identify and recover additional reimbursements. After the initial success, the
ASC added our Upfront Recovery Services as well
A mid-sized Behavioral Health Group employs a billing company to assist with all claims management. However, due to the center’s high volume, the billing company is unable to devote enough resources to identify and appeal underpaid out-of-network claims. Working alongside the billing company, Collect Rx was able to find claims to be appealed and helped recover over $1M.
A Behavioral Health Group with multiple locations and a combination of in and out-of-network claims, has a billing company to assist with claims management. Being out-of-network, the facility receives a large amount of upfront negotiation requests that fall outside the billing company’s standard process. Working alongside the billing company, Collect Rx was able to negotiate these requests and helped generate over $3.9M in collections.
A mid-sized lab company employs a billing company to
assist with all claims management. Typically, due to high
volume and low disputed amounts, it’s inefficient for the
billing company to work on cases for appeal. Working
seamlessly alongside this lab’s billing company, Collect Rx
identified and appealed underpaid out-of-network claims,
and was able to find claims to be appealed and helped
recover over $4M.
A Texas freestanding emergency center asked Collect Rx to improve reimbursements in its appeals department. The FSER’s administrator remarked that their original billing company ceased working with them because he “asked too many questions.” For that reason, he had difficulty obtaining older claim forms.
As providers look at the financial landscape today, there are fewer opportunities than ever before to improve their
revenue profile. In-network contracts are set with very little opportunity to move the needle. Medicare and
Medicaid are immutable. Out-of-network represents the last great opportunity for many providers to improve their
reimbursements and, as a result, their bottom line.
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