CONTRACTUAL NET REVENUE FORECASTING

 

Gross-to-net expected reimbursement forecasting is a significant challenge many providers face today. Due to multi-channel transactions and variances within pricing and payer contracting, providers often struggle to properly manage data and determine reasonable and supportable revenue forecasting. With our customized payer calculators, we are able to net down each claim by payer for each service immediately after the claim is billed. 

 

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We Provide Revenue Forecasting to Assist Providers in Tackling and Managing Net Revenue

 

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01

Expected net revenue within 30, 45, or 60 days, billed with no payer activity

Payer by plan

Visit type

Facility

Physician

02

Expected net revenue within 30, 45, or 60 days, on appealed claims

Payer by plan

Visit type

Facility

Physician

Reason

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03

Outstanding denials and underpayments that have not been reviewed

Payer by plan

Visit type

Facility

Physician

 

04

Outstanding "aged" patient responsibiliy

30, 60, 90, 120 > 120 days

DNFB

10, 15, and > 20 days

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Denial and Underpayments Facts

The sheer volume of claims along with the complexity of reimbursement increases the challenge to place a value on claims that have been either underpaid or denied. Healthcare providers struggle with knowing if underpayments and denials are reviewed and worked or simply written off and not pursued. Some denials and underpayments industry averages:

Underpaid claims average 7-11% or more

On average, it costs $25 per claim to re-work each underpayment and/or denial

Denied claims average 5-10% or more

Approximately 65% of denied claims go unresolved

Only 35% of medical groups appeal denied claims

 

 

In addition to forecasting expected net revenue on newly billed claims, we further provide net revenue forecasting on payer underpayments, where you can know the value of the underpayment as well as how much revenue is anticipated to be recovered. Similar to the underpayment net revenue forecasting, we identify denied claims. Once the collector reviews and appeals the denial, we forecast the revenue associated with each denial and the timeliness to expect full payment.

Contact us today to find out how you can start accurately forecasting expected revenue and collecting 100% of your claims.

 

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Download Revenue Masters CvC — our mobile app for iOS and Android.

Use CvC (Collected vs. Collectable) to monitor your team’s payer collections progress and see all of your quick charts 24/7. Monitor payer collection performance with an eye towards achieving 100 percent payer collectability.

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