About

ABOUT US

Our Experts Are The Finest

At MedexHM, we are motivated and excited to help healthcare companies build better versions of themselves. With every client, we bring a distinctive touch and unwavering curiosity to pursue an insight-led and people-first solution.

We are here to provide realistic and executable recommendations that are clear, simple, and effective. Proven methods have been developed by our expert team through years of experience. The collaboration of our clinical quality experts, finance executives, strategists, healthcare equity experts, operational leaders, and digital advisors collaborate with our clients, at all levels, to develop practical solutions that deliver repeatable and sustainable results.

In addition to the array of consulting services offered, MedexHM offers an industry leading Underpaid Claims Recovery service. This is the most advanced underpaid claims recovery solution in the healthcare industry with a proven recovery success rate of 100% of underpaid claims typically ranging from 10% - 30% of annual Net Patient Revenue. Most other competitors recover an average rate of only 3.5% while using traditional RCM methods.

ASK US HOW we can deliver substantial claims revenue back to your bottom line.

Consulting

CONSULTING SERVICES

Taking Your Business To The Next Level

Cloud Based Data Management

All your data security and management simplified. Run multiple cloud data services, including Backup, threat defense, cyber vaulting, data classification, Disaster Recovery, and much more. MedexHM helps clients establish a scalable, integrated, secure technology platform.

Healthcare Cyber Security

Organizations face complex security challenges, including phishing, trojans, ransomware, infrastructure issues, and more. Our cybersecurity team will help guide you through technology and healthcare enterprise risk management scenarios to identify and address security threats.

Revenue Cycle Management

From insurance verification to prior authorization to managing practice revenue, MedexHM will help simplify your RCM processes. With our guidance, we will unify the business and clinical sides of your healthcare practice to maintain financial visibility while continuing to provide quality care.

FLAGSHIP PROGRAM !
Underpaid Claims Recovery

The Underpaid Claims Recovery program is the only underpayment recovery solution of its kind in the industry utilizing proprietary custom-built software to audit and identify underpayments on all “zero-balance” and previously adjudicated claims.

This program is not part of any existing Revenue Cycle Management efforts that your organization may currently be performing. It is a completely custom-built program designed specifically to audit previously adjudicated claims AFTER all other audit and collection procedures have been completed.

Once your Revenue Cycle Management team has fully adjudicated a remittance, that has already gone through your healthcare entity's internal and external processes, is when the process starts.

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UNDERPAID CLAIMS RECOVERY
Program Highlights

While most healthcare facilities currently use or have used software that recovers underpayments via their Revenue Cycle Management system, such as Epic, PMMC, or CloudMed, these software programs typically recover underpaid claims at a rate of only 3% -5%. The proprietary software used here recovers an average of 10%-30%.

The audit analyzes every remittance received in a 12-to-24-month period to determine contractual compliance of each reimbursement. A team of specialists then collaborate with the payers to recover underpaid claims that are due to the client.

The forensic audit is not an "ancillary service”, therefore typically recovering underpaid claims at a rate of 10%-30% of annual Net Patient Revenue, 100% of the time. All payments are made directly to the healthcare facility.

The underpaid claims recovery service is a risk-free addition to your Revenue Cycle Management efforts. The forensic audit is performed on remittances AFTER all other RCM efforts have been completed. The process only targets remittance files that clients expect no further revenues. Therefore, this service compliments all other RCM efforts and provides new revenues…100% of the time.

Using the proprietary software, billions of dollars have been analyzed in reimbursements and remittances against 1,000s of unique and often complex payer contracts and noncompliance and underpayments have been found 100% of the time.

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The success of the recovery program is based on a contingency platform. There are no upfront fees, costs, or any ongoing tasks required from the client. 100% of the risk and effort is taken on by the company to recovery revenues for you. Compensation is considered only when there is successful recovery of underpayments and after the healthcare facility gets paid.

UNDERPAID CLAIMS RECOVERY
Steps To Success

Agreements are executed with the client

Healthcare entity uploads all their electronic remittances (835s & 837s) into an encrypted, safe, HIPAA compliant platform

Our specialists will custom program the proprietary software to analyze the client's claims and insurance contracts to identify certain patterns and trends

Once underpayments have been identified, our team will establish a precedent of codes and claims paid vs. same codes and claims not paid and start a dialogue with the insurance providers

Our team manages all filing and any disputes or challenges throughout the entire process

Once settlements are reached, the insurance providers remit the underpayments recovered directly to the healthcare facility

All steps are performed at NO COST to the healthcare facility

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