Million-Dollar Discovery: Cancer Centers Recover Over $3 Million

Challenge:

Two designated PPS-Exempt Cancer Hospitals were entitled to additional Medicare Advantage payments that their internal variance tools weren't built to price. Certain payers had never made these payments, so the centers weren't tracking the gap. Revenue was leaving quietly, with no internal mechanism to catch it.

Solution:

Revecore's technology includes custom-built exceptions for designated cancer centers, which allows claims to be priced to their full allowable under PCH rules. Once the issue was identified, the Hospital Infusion team alerted both centers and began working more than 1,400 accounts with the relevant payers to recover proper reimbursement across the affected population. 

Results:

Specialized reimbursement expertise revealed a hidden payment gap that had gone undetected for years. 

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