Outpatient Revenue Recovery

All hospitals risk Medicare underpayments. 

The complexity of OPPS and the Revenue Cycle virtually guarantees it. A complete zero-balance 4 year retrospective Medicare OP review will identify hard to find opportunities for improvement and recover hard to recover revenue that your hospital earned and deserves. VHC's OP Revenue Recovery Service works behind-the-scenes with virtually no disruption to your business office.

Revenue Recovery

Hospital outpatient claims data is scrubbed through our proprietary software that reviews for more than 450,000 edits, finding issues with charge capture, improper coding, denials, and billing errors. 

Our review is a true chart to claim audit. We compare your medical record against the payment received to indentify opportunities for capturing additional revenue. This retrospective review allows us to find improvements and revenue potential that most internal processes miss. 


Areas of Opportunity:

  • Missing/Invalid HCPCS and CPTs

  • Coding Specificity - under/missed coded procedures

  • New CDM charges not linked to Order Entry

  • Nursing charges: observation, drug and transfusion/infusion administration

  • Incorrect modifiers, revenue codes or billed quantities

  • Billing errors - edits for CCI, NCD, LCD & MUEs
  • Missed code pairings & add-on codes

  • Validation of OP cost outliers


Our fees are contingent on results.

We don’t get paid until you get paid.

Learn how VHC can help you recover lost revenue, increase payments and reduce unintended write-offs through an integrated approach to denial management and revenue recovery.

Call us today at 630-620-9178 to learn more.

Why audit outpatient claims?

Many hospitals perform inpatient and DRG analysis. Many fewer take the next step to audit outpatient claims. Yes, outpatient audits are more difficult. Most hospital revenue cycle operations and third-party administrators don’t have the resources to conduct them. But our extensive experience shows that they’re missing out. Outpatient claims audits do provide real value.