CERiS White Paper Highlights Advantages of Pre-Payment Claims Review

Rhea-AI Summary

CERiS, a CorVel company, released a white paper advocating for pre-payment healthcare claims reviews. The document highlights challenges and benefits of this strategy, such as avoiding lengthy reversal processes and reducing provider friction. Notably, CERiS claims an average savings of $9,000 per claim and a decrease in appeal rates from 10% to 3%. With 97% of negotiated hospital claims having charge errors, the shift to pre-payment reviews is positioned as a significant improvement for health payers. The white paper is available for download on their website.

Positive

• Average savings per pre-payment claim can reach $9,000.
• Appeals rate for claims can drop from 10% to 3%.
• Pre-payment reviews can prevent costly errors before payment is made.

Negative

• None.

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.

About CERiS
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.

About CorVel

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

Phone: 949-851-1473

www.corvel.com

FAQ

What is the main focus of CERiS's white paper on payment integrity?

The white paper emphasizes the benefits of implementing pre-payment claims reviews to reduce errors and improve the efficiency of the claims process.

How much can health payers save on average from pre-payment claims reviews as per CERiS?

CERiS suggests average savings of $9,000 per pre-payment claim reviewed.

What reduction in appeals rate does CERiS claim with pre-payment reviews?

CERiS claims that pre-payment reviews can lower the appeals rate from 10% to 3%.

How prevalent are charge errors in hospital claims according to CERiS?

CERiS states that 97% of negotiated hospital claims contain at least one charge error.

When was CERiS's white paper on payment integrity published?

The white paper was published on August 16, 2022.

What challenges do post-payment claims reviews present according to CERiS?

Post-payment claims reviews can take months to reverse incorrect payments and often do not recover all improperly paid money.