Medical Revenue Recovery Services

Medical revenue recovery services help practices identify and address revenue that is delayed, denied, underpaid, uncaptured, or left uncollected. For infectious disease practices, this may involve claims, infusion and drug billing, OPAT authorization, hospital consults, payment reconciliation, payer contracts, and aging accounts receivable. The goal is to connect financial findings with the workflow or documentation issue that caused them.

Revenue leakage can originate before a claim is submitted or after payment is received. Reviewing charge capture, coding, documentation, authorization, payer classification, contract terms, remittance details, and aging accounts receivable can reveal where expected revenue is lost or delayed. Analysis by payer, service line, provider, and claim type helps practice leaders distinguish isolated problems from recurring workflow patterns.

Support can address evaluation and management claims, hospital consults, infusion administration, drug claims, OPAT-related services, and complex outpatient visits when those services are part of the practice’s workflow. The review may include charge entry, coding, claim scrubbing, submission, rejection clearing, denial follow-up, payment reconciliation, and aging account work. The exact scope should reflect the practice’s systems and service lines.

Yes. Denial work can categorize root causes such as drug and administration coding, missing authorization, medical-versus-pharmacy benefit confusion, under-documented consults, or other claim and workflow issues. Payer-specific appeals can be supported with relevant clinical documentation, while the findings can be shared with clinical, coding, and front-office teams to reduce repeat denials.

Underpayment review compares payer payments with expected reimbursement for applicable drug, administration, and evaluation and management claims. The review can flag short-pays, incorrect fee schedule application, and unit or NDC mismatches. Findings are documented for dispute and recovery, while patterns may also indicate a need to review contracts, billing workflows, or payment posting practices.

Yes. Infectious disease revenue-cycle guidance can address referral, eligibility, authorization, drug acquisition, infusion billing, documentation, claims, payment follow-up, and final reimbursement for OPAT and infusion workflows. This is especially relevant when a practice is launching a program, adding providers, or evaluating whether operational processes are keeping pace with the financial requirements of the service.

No. GrowInfectiousDisease explicitly avoids publishing invented rates, benchmarks, drug acquisition costs, payment rates, or margin figures. Its tools and guidance allow practices to apply their own numbers and distinguish verified information from figures that depend on a specific payer, contract, service, workflow, or practice configuration.

The resource hub offers free, ungated resources and calculators, with no email required to receive a result. Calculator tools run in the browser without transmitting or storing user-entered data. Practices can use the guidance to examine revenue streams, operational decisions, and financial sustainability while keeping their own practice-specific figures under their control.