Hidden Opportunities: ‘Second Pass’ Audit Unearths $2.5M for Medicare Advantage Plan

Opportunity

Payment Integrity organizations employ a combination of subject matter experts and proprietary technology, which means that the results each entity achieves has potential and limitations specific to their technology and the people behind it. As a result, many payors use multiple payment integrity organizations to amplify the level of expertise evaluating claims payments in order to maximize their recovery results.

Solution

We were engaged as the “second pass” auditor for a 47,000 member Medicare Advantage plan, behind a large, national healthcare analytics and recovery organization. Utilizing the expertise and knowledge of our team, our detailed scrutiny uncovered missed claim recovery opportunities in the amount of $2.5MM total dollars, back to the plan and ultimately, their members.