The current complexity of managed care contract language and terms has resulted in significant increases in technical denial levels and unwarranted reductions in payment levels for many providers.  In addition, denial levels have increased as payers utilize “smart” software to validate charge levels and identify unrelated services through CPT and UB code comparison.  The resulting impact on revenue levels for providers has been significant and, in some cases, has threatened the financial viability of providing certain medical services.

CBIZ helps providers to reduce lost revenue due to managed care denials and payment reductions by modifying managed care coding and compliance processes.   Services provided include:

• Clinical Coding Compliance Review of existing managed care contracts to identify potential areas of revenue exposure. 
• Review of selected patient accounts, based on our findings from the initial Compliance Review, to determine whether revenue erosion has begun and to what extent.
• Presentation to management regarding the review findings, including new programs and/or revisions to existing practices that are required to reverse the existing erosion of revenues and opportunities to recover monies from the managed care payers.