CERiS White Paper Highlights Advantages of Pre-Payment Claims Review
Company is Leader in Payment Integrity Solutions
FORT WORTH, Texas, Aug. 16, 2022 (GLOBE NEWSWIRE) -- CERiS, a CorVel company, and a leader in both pre and post-pay health care claims review today announced a newly published white paper on payment integrity that urges health payers to consider a pre-payment claims review strategy while outlining the challenges and benefits of doing so.
The white paper notes the advantages of undertaking such reviews before money changes hands. Among them:
- It can take months to reverse an incorrectly paid claim
- Payers don't usually recover all money improperly paid as the result of a post-payment review
- Reviews of disputed claims often require a time-consuming appeals process
- Pre-payment reviews avoid "provider abrasion" by paying the claim correctly the first time
In instances where CERiS has provided pre-payment claims reviews, the average savings per claim can be as high as $9,000, while the appeals rate of claims can drop from 10% to 3%.
"Given 97% of all negotiated hospital claims contain at least one charge error, switching to pre-payment review can avoid numerous pain points that come with undertaking post payment claim reviews and claw backs," said CERiS President Greg Dorn.
The white paper on payment integrity may be downloaded here.
CERiS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its proprietary universal chargemaster contains billions of charge items from more than 97% of the nation's hospitals, helping to ensure the accuracy and objectivity of each claim review.
CorVel Corp. applies technology including artificial intelligence, machine learning and natural language processing to enhance the managing of episodes of care and the related health care costs. We partner with employers, third-party administrators, insurance companies and government agencies in managing worker's compensation and health, auto and liability services. Our diverse suite of solutions combines our integrated technologies with a human touch. CorVel's customized services, delivered locally, are backed by a national team to support clients as well as their customers and patients.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995
All statements included in this press release, other than statements or characterizations of historical fact, are forward-looking statements. These forward-looking statements are based on the Company's current expectations, estimates and projections about the Company, management's beliefs, and certain assumptions made by the Company, and events beyond the Company's control, all of which are subject to change. Such forward-looking statements include, but are not limited to, statements relating to pre and post-pay health care claims review services and the Company's continued investment in these and other innovative technologies, and statements relating to the Company's workers' comp service offerings. These forward-looking statements are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause the Company's actual results to differ materially and adversely from those expressed in any forward-looking statement, including the risk that the impact of the COVID-19 pandemic on our business, results of operations and financial condition is greater than our initial assessment.
The risks and uncertainties referred to above include but are not limited to factors described in this press release and the Company's filings with the Securities and Exchange Commission, including but not limited to "Risk Factors" in the Company's Annual Report on Form 10-K for the year ended March 31, 2022, and the Company's Quarterly Report on Form 10-Q for the quarters ended June 30, 2022, and September 30, 2021 and December 31, 2021. The forward-looking statements in this press release speak only as of the date they are made. The Company undertakes no obligation to revise or update publicly any forward-looking statement for any reason.
|Contact: Melissa Storan|
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