Fixing payment integrity at the source
Find out how eligibility management plays a role in maximizing recovery opportunities, improving cost avoidance strategies, and creating premium restoration possibilities.
Read MoreAdd millions to your bottom line
A key factor in successfully managing Medicare Advantage plans is ensuring you receive accurate premium payments from the Centers for Medicare and Medicaid (CMS). However, ongoing inaccuracies with member eligibility information and disease status markers mean that many health plans don’t get the dollars they’re owed.
As your premium restoration partner, Discovery Health Partners can help you restore and protect the premiums you deserve. Whether optimizing Medicare Advantage revenue or proactively managing disease statuses, we ease the administrative burden of finding errors and making corrections—improving your efficiency and productivity and ultimately restoring millions of additional premium dollars for your plan.
The latest in Premium Restoration
Infographic
Medicare Secondary Payer (MSP) validation and restoration
We’ve worked with over fifty MA plans to get the most updated status on their members and restore underpaid CMS premiums. In every case, we recovered more than the plan could on their own. Click to see examples of the millions in savings that you could be adding to your bottom line.
Ways we help
Data analytics
Unlock the hidden value in your data and collect the full value of premiums owed to you for managing MA members
Expert process
Achieve clarity, consistency, and improved results with best practices and highly skilled staff to guide you through every step of the restoration process
Improved efficiencies
Reduce the time spent identifying root causes and recovering claims with ongoing support to ensure you continue to receive correct premiums
Our Premium Restoration solutions
Medicare Secondary Payer Validation
Could millions of dollars be hiding in your MSP validation process? On average, 4% of Medicare Advantage members have open MSP records and 50% of those records have premium restoration potential. Our MSP Validation and Premium Restoration solution quickly and accurately validates MSP records, corrects inaccuracies, and restores millions in underpaid premium dollars.
ESRD Premium Restoration
Members with end-stage renal disease (ESRD) account for a disproportionate amount of medical expenses. Without a plan to identify these members, your Medicare Advantage plan could be missing out on millions in additional premium dollars CMS should be paying for your members with ESRD. Our ESRD Premium Restoration solution helps identify members with missing ESRD statuses and restores millions in underpaid ESRD premiums.
Medicare Advantage plans leverage Discovery’s expertise in Premium Restoration to supplement their internal premium reconciliation efforts.
Why Discovery?
Proprietary analytics and data modeling
help identify members with the greatest propensity for inaccuracy and premium restoration potential
Our positive relationship with CMS
helps resolve errors and inaccuracies quickly and painlessly using their tools and processes
Close monitoring of membership and CMS data
offers visibility into premium restorations and the CMS submission and acceptance process
A complete electronic audit trail
of every completed validation and restored premium simplifies compliance and record tracking
Related resources
Jason Brown on the road ahead for payment integrity
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It’s challenging to identify and restore underpaid ESRD premiums. Here’s how to solve that.
Every year, plans lose out on millions in revenue due to underpaid ESRD premiums. A systematic process can help plans gain control of ESRD data and restore premium revenue.
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Infographic: ESRD has a major impact on Medicare Advantage financials
MA plans are challenged with receiving the correct premiums from CMS for members with ESRD. View this infographic to learn more.
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Why Medicare Advantage plans may be losing money on members with ESRD
CMS pays higher premiums to cover the higher costs of ESRD care. When these members are not correctly identified, plans can miss out on millions in revenue.
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Webinar: Restoring underpaid CMS premiums for members with ESRD
The process of identifying and restoring underpaid ESRD premiums is time-consuming and complex. This can stand in the way of maximizing the premiums you deserve for your membership with ESRD. View this on-demand webinar to learn more.
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Four tips for balancing the effects of Medicare Secondary Payer
Medicare Secondary Payer (MSP) is a multi-pronged issue for Medicare Advantage plans. If plans aren’t monitoring the effects of MSP...
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Webinar: Walking the line – balancing claims, premiums, and compliance for Medicare Advantage plans
Listen to Discovery Health Partners’ Medicare subject matter expert, Amy Cogsdill, as she discusses the delicate relationships between premium recovery, claims payments, and compliance for Medicare Advantage plans.
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Webinar: 2017 Trends in healthcare payment integrity
Managing costs is the fundamental challenge facing all health plans today, and payment integrity is at the heart of this issue. In this exclusive webinar on demand, payment integrity experts Paul Vosters and David Grice discuss the eight major payment integrity trends that have emerged in 2017 and offer recommendations for health plans that want to capitalize on those trends.
Read MoreContact us today for more information on accelerating your payment integrity results
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