LMRP and ADR Lost Revenue Recovery Program

Over the past year, Healthcare facilities have written-off a significant amount of Medicare revenue due to NCD LMRP-related denials and/or Additional Development Requests (ADRs).  Some of the reasons for rejections and denials are:

(1)    Physicians often are unaware that terminology used for Part-B billing may not support a hospital’s claim

(2)  Coders often do not have access to and/or lack training in dealing with NCDs/LMRPs that impact coding & billing

(3)   Limited information is available in the medical record, physician’s orders or outpatient registration at the time of coding and/or is not considered in the coding process

(4)  Significant increase in outpatient tests with limited hospital resources to code theses claims.

(5)   H.I.S. limitations, which result in a lack of an appropriate number of Diagnosis Codes appearing in the claim.

With Medicare’s plan to add more national & local edits for determining medical necessity, and increase requests for ADRs, hospital write-offs will continue to increase in the coming years.

We can assist your hospital in significantly reducing its write-offs for LMRPs and ADRs. We will typically recover payments for as much as 50% of a hospital’s denied or rejected claims. We believe a  5:1 ROI recovery is attainable for what would otherwise have been written off as bad debt.

Benefit for the Hospital

ü   Risk free solution to recover Medicare Revenue that will be written-off due to LMRPs or ADRs (100% of our fees are tied to increased collections)

ü   Decreased write-offs for LMRPs and ADRs

ü   Increased effectiveness for related hospital processes, thus reducing future write-offs

ü   Improved Hospital – Patient Interaction

ü   Compliant Claims = Appropriate Reimbursement

Our Results