What exactly does D&R do?

Discover & Recover, a healthcare consulting firm with decades of experience in the industry is dedicated to providing resources to hospitals and healthcare systems in the areas of Payer audits and Revenue Recovery. D&R is committed to recovering any additional revenues that may have been underpaid by the insurance carrier.

How do you get the data you need to perform your audit?

There are three basic methods of retrieving the patient account data that is needed. First, by electronic remote access to your patient accounting system, or second; an electronically submitted file containing all data elements, and finally a hard copy paid claims report.

Are there any HIPPA issues with the transfer of data?

No. Currently, under the HIPPA guideline, D&R falls under the ´┐ŻBusiness Associate´┐Ż title. D&R enters into and agreement to abide by all internal policies and procedures and treats all patient data accordingly. All electronic transfer of data is handled appropriately.

How do I know if I am being underpaid from my managed care organizations?

Chances are that you are experiencing underpayments. Unless you have the internal resources who have the proper training to dedicate to reviewing your paid accounts, you may never find them. Industry estimates range anywhere from 7% - 15% of managed care revenues are lost due to a lack of review taking place.

Does D&R accept the recovered payments?

No. All payments will go through the normal process of the hospital revenue cycle. D&R never receives payments on the clients behalf. The D&R staff does provide the tracking process to ensure that the identified underpayments are proceeding properly through the carriers payment cycle.

How does D&R price its services?

The review process is contingency fee priced. That is, once underpayments are received by the hospital business office, D&R then submits an invoice to the client. If D&R cannot find any payment issues, than the client pays nothing. Our service is risk free for the client with zero cash outlay to initiate project.

How long will it take for an audit to take place?

D&R will review all of your payer contracts for any components where underpayments may occur. Depending on the size of the client and account volume, this may take up to 60 days. Once the underpayments have been submitted to the insurance carrier, D&R expects the client to have payment on the underpaid claim within approximately 60 days. Clients can expect the entire process to take up to 120 days.