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 is an industry leader in Underpaid Claims Recovery services. We offer the most advanced forensic audit system 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. Our competitors recover an average rate of only 3% 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.

OUR FLAGSHIP PROGRAM !
Underpaid Claims Recovery

Our 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.

We perform our audit once a remittance has been fully adjudicated and has already gone through your healthcare entity's internal and external processes. Our audit begins once your Revenue Cycle Management team has fully adjudicated a remittance.

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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 2% -5%. With our software, we recover an average of 10%-30%.

Our audit analyzes every remittance received in a 12-to-24-month period to determine contractual compliance of each reimbursement. Our team then collaborates with the payers to recover underpaid claims that are due to our clients.

Our forensic audit is not an "ancillary service”, therefore we typically recover 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.

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

To date we have analyzed billions of dollars in reimbursements and remittances against 1,000s of unique and often complex payer contracts and have found noncompliance and underpayments for 100% of our clients.

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We work solely on a contingency basis. There are no upfront fees, costs, or any ongoing tasks required from our clients. We take on 100% of the risk and effort to recovery revenues for you. We are only compensated when we successfully recover underpayments and after you are 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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