Revenue
Integrity Solutions

Denials Recovery

Denials are on the rise amid challenges in resources, staffing and technology limitations. Hospitals need a trusted, tenured partner to quickly and effectively address denials from commercial and government payers. That’s where Revecore comes in. Our Denials Recovery solution offers complete denials and appeals management to recover your rightful reimbursements, ensuring you have the revenue necessary to deliver exceptional patient care. With a configurable implementation protocol deployable in Day 1, Overflow, and Aged capacities, our solution has the flexibility to address your key denial problem areas.
Our team of skilled clinicians, nurse consultants, certified coders, and experienced claim analysts provides unequaled guidance on denials and payer practices. Knowing that prevention is key, we offer strategies to identify fail points, improve processes, and enhance recovery efforts to maximize cash flow. Our deep reporting and case studies highlight root causes and emerging trends. When standard appeals aren’t enough, our tenured Managed Care experts step in to support effective payer escalations, ensuring your accounts are resolved.

Zero Balance | Underpayment Recovery

Recover underpaid claims with our multi-prong approach to review and recovery encompassing payment variance, billing and coding issues and zero-balance denials.
We remove the guesswork with sophisticated automation custom-built to identify underpayments, as well as specialized expertise to address the many drivers of underpayments and recover more revenue. Our proprietary system utilizes 2,000+ algorithms, ensuring precise and thorough identification of reimbursement opportunities. Claims go through a hierarchy review from highly skilled claims analyst teams, including over 21 specialty teams, resulting in industry-leading recovery rates.

Transfer DRG Identification Recovery

Managing Transfer DRG underpayments can be daunting and time-consuming, often leading to significant payment reductions for hospitals. Our solution simplifies the process and ensures accuracy, so that you can capture every dollar you are owed. We take away the manual lift of recovery with proprietary technology that combines algorithms and pricing tools to easily identify claims with potentially reduced reimbursements.
Our experts meticulously review claims to verify patient transitions post-hospital discharge, and work directly with Medicare, Medicare Advantage plans, and post-acute facilities to ensure accurate reimbursement of claims, alleviating the burden on hospitals.