Underpayment Recovery, you threw it in the trash, we're going to dig it out on our dime!!
We are not here to change anything your RCM people are doing, what we do we're going to do come in after everything they do. You bought software, great, keep your software. You have your teams, fantastic! I'm sure you love your team, if you didn't, you would have already replaced them. We are not here to replace either. You have a third party consultant, great, God bless you, keep your consultant. We are not here to change anything.
The reality is, all of these institutions are going to work their batches and as you know, it's called the revenue cycle and they are going to work it for a window of time, they all have their own protocol. Statistically speaking, 90% are going to work it, for say 90 days to 120 days. The remaining 10% are going to be, I don't know, something unique. That's fine, we've got that covered as well.
So, if you are going to work your revenue cycle for 90 days and I'm not going to change anything, when I come in, I'm going to come in on the 91st day and I don't want anything to do before then. In other words, when you worked, when you've gone through everything you can do, all your steps, all your processes, all your software, all your professionals, all your appeals, everything you're going to do and you say "okay, that's it, I've done what can, I'm going to walk away now because my attention needs to go to current items, current batches, current billing, current revenue cycle." That's when we enter.
Another way to look at it, is you threw it in the trash and I'm going to dig through your trash now to make sure that you didn't leave anything in there of value. That's exactly how you need to look at us! We're a stop loss, we're a quality control measure. So you work your batches for 90 days, I come in on day 91. By the way, I come in on my dollar, there is no front-end cost, there is no risk to your institution whatsoever, none whatsoever. Not one red cent, it's all on our dollar.
So we come in on the 91st day, we say "give us your files, I'm not going to go into your systems, I'm not altering your contracts, I'm not looking at anything. You're going to send me, through my secure link, you're going to send what's called your 835's, it's your billing paperwork. It's going to show me what you did, it's going to show me what you bill for and it's going to show me what you were paid. Now, I know you're thinking to yourself "well if it shows them all that, why can't we find it ourselves?" Because there's volumes of games that are played, there's way too much to dig through, they're way too buried, but there's no software outside of ours, and that's a real critical component, there's no software that looks explicitly for underpayments!
Now you may hear that there's other software out there, for example Cerner software, a great piece of software. Epic software, amazing piece of software. And I'm not being facetious or sarcastic when I say that, I mean it's great software. Is it better than us? Yep, it's better than us at all things we don't do. Is it as good as us at the thing we do? No, can't touch us and every medical institution in the country using us will tell you that. These other softwares are overly general, they're going to handle your revenue cycle, they're going to handle your contract management, your denials, they're going to do all of that stuff. That's fine!
Well, I'm going to ask you if I give you something that can go into any type of medical institution, no matter how small, no matter how large and can do all of these different things and even within all of these segments of medical, whether it's Primary Care, Urgent Care, Surgical Center, hospitals, whether it podiatry, optometry, whatever it is, I think you're kind of seeing where I'm going now, right now it's very general, right? It's amazingly powerful, but it's very general and anytime you do general work, what you're not doing is precision work and see, that's what we do, and so we're going to get all your 835s, we're going to get your payer contracts and we're going to load that into our proprietary software. Now what our software does, when I say proprietary, I mean we built it from the ground up. It doesn't exist anywhere else, nobody built it for us, it's not white labeled. It is exclusive in the market space. Kind of our hallmark company when you look at us, as an institution there's nobody that does what we do. We've innovated market after market, we innovate how things are brought to market. We don't want to play on a level field.
We want to do what nobody else does in a way that nobody else can do and make life easier. So we upload all this stuff into our software and we run this, it only takes a brief window of time, we're going to have results inside of 48 hours, it's a really a quick turnaround for everybody we're working with. Now what this software does is it tells us where the hotspots are and what I mean when I say "hotspots," when we get enough data we're going to see errors in underpayments across the board in every form of billing code, every single one, but because we are a contingency based platform because we are doing all of on our dollar, we don't have the luxury to go after every single penny. We want to go and see where the bulk of the activity is, where the bulk of the underpayments are and that's exactly what our software tells us and believe it or not, no matter what institution we go into, we're going to see an aggregation of underpayments into a finite number of billing codes, there's certain patterns that develop, they show themselves and this tells us with further refinement, further laserlike focus where do we need to give our attention to, based on that information we now rebuild the software from the ground up, completely from the ground up!
What's that mean? Your contract, your contract terms, all of the minutia, all the is if this then that etc. that's in the contract, all of your actual medical procedures, all of your billing, all of your payments, in other words, completely custom software to your institution not applicable to the next hospital down the road, the Urgent Care Facility 200 feet away, the primary care practice whose primary doctors moonlight the hospital of surgery couldn't apply to any of them. It is just your software and it's just focusing on one area, the limited area we need to focus on, just looking for one thing.
Do you see why now I'm able to comfortably come in and talk to any medical institution and say "don't bail on your software, don't bail on your other professionals, we're not a threat to anybody." Let them do what they do, we're still going to come behind them and find what they can't find. That shouldn't be threatening, this is just another arrow in your quiver, that's who we are, that's what we do. Now, we go through and we run this software, right and in running the software we're able to identify where the problem areas are and then we go through and we perfect the process and we start getting your medical institution paid a little bit here and a little bit there to perfect our process and refine everything yet further. Part of our secret sauce is on the human side of things as well, it's not just that we have this amazing software unlike anything else in the industry. It's not enough that we go to the next level and we build custom software, after that, we go a step further and now, we the human, step in and we go after the payers we used to work for, the payers. In fact we won't hire anybody that hasn't worked in a management capacity, the very people that strategize and pull these games against the medical facilities. We talk about the dark side and the good side, we take them back from the dark side!
By the way, we get the revenue flowing inside of weeks and then inside of a couple of months we work to a settlement with these payers and we see piles and piles and piles of money drop into the pockets of the medical institutions further mitigating any concern, any risk they think they might have, all the money flows straight to them, not us.
And then it's done? Well, truly it's not done, the reality is these medical institutions recognize that because we solved the problem for this window of time we looked at, we usually look at about two years, but we'll go back as far as five. They know it's going to keep happening, so they re-engage us again and again and again and can turn into lifetime revenue for them and now whether they re-engage us in the form of leasing our software or in the process I just described, they want us to just keep redoing, that's immaterial. The point is it creates this opportunity for them again, and again and again!
As an example, on a revenue of $100M, we expect to find 10-20% identified revenue. Let's go with 10%, that means for every million that they've been paid, we expect to find at least another $100,000, at 20% another $200,000. The actual mean is 22% which means $220,000 they're owed straight from the insurance companies. We're not going after the patients, there 1000's of people doing that. On this side, what we do, there are those that purport to do what we do but their success rates range from 0.5 t0 3.5%
Now on that $100M facility, which could be a rural hospital, a surgical center, anything, our average is $22 million that we're going to find per year, we're going to audit two years, three years, four years, five years. That number escalates and now we are going to go back when we seek settlement, we're going to go back with our aggregate number to the payer, to the insurer, the insurer is going to kick up a fight and say "well wait a minute this contract for example, most contracts say they can only audit them for a year, some say 2 years and a minimum percentage are open-ended meaning you can audit them forever. Let's say we look at the worst case scenario, we're giving them $22M or $44M if we go back two years, but the insurer says "no, no you can only go back one year" but their contract also has fines, sanctions, penalties and now with elections going on, the crippling nature of insurance, of medical expenses of drugs so on and so forth, both political parties are talking about it all of the time, so most insurers are willing to seek settlement on those extra years instead of being exposed to attack by politicians of both parties!!
Ready to start a conversation yet?
Email or text me and I'll get you to the top two people of our company.
Thank You,
Larry Potter
Senior Advisor
Lgpotter33@gmail.com
Text: 847-872-4047
