Pennsylvania Workers’ Comp Recovery Solutions

OVERVIEW

In the health care industry, where margins are extremely thin, capturing every possible dollar due to the hospital is vital. But many Pennsylvania hospitals do not fully realize their fair share of payments from workers’ compensation claims. This is because it is difficult for hospitals to accurately calculate the correct expected payment for Pennsylvania workers’ compensation claims. Many hospitals do not know if they have been paid correctly or not. So we have created a service that evaluates the Pennsylvania workers’ compensation payments that are due to your organization and compares that amount to your actual payments. We will recover underpayments from insurers or, if the claim is within timeliness guidelines, file an Application for Fee review with the Pennsylvania Bureau of Workers’ Compensation.

KEY BENEFITS

Instead of tying up your billing staff with this ultra-specialized task, you can count on SunStone to work on your behalf. Using our wealth of experience, we will:

  • Process historical claims to uncover opportunities on underpaid claims
  • Review medical record and billing documentation to determine if an Application for Fee Review is warranted
  • Estimate the financial impact of all underpayments
  • Evaluate opportunities to improve cash flow by outsourcing accounts receivable to SunStone

As a result, you will recognize more net patient revenue and show lower and more accurate contractual adjustments for workers’ compensation claims.

WHY IS THIS THE BEST SOLUTION?

First, nobody matches our expertise. We use a process that blends extensive clinical and technical experience with a proprietary software edit tool that identifies opportunities to recover underpayments for historical claims.

Our only known competitors are collection agencies, who simply try to recover a fixed percentage of total charges. SunStone actually performs claim-by-claim calculations to determine the correct payment on each claim, and then pursues that amount. And unlike collection agencies, we frequently file Applications for Fee Review with the PA Bureau of Workers’ Compensation.

WHAT OUR CLIENTS SAY

We are often complimented on how we collect additional money when clients felt no additional collections were possible. Also, clients appreciate our professionalism when dealing with insurance companies and the PA Bureau of Workers’ Compensation.

PART OF AN EVEN LARGER SOLUTION

This recovery solution integrates seamlessly with our other PA workers’ compensation services, including our CDM update and claim pricing services.

LEADERSHIP

Timothy M. Mosco, M.S.