Questions to ask any Payment Integrity & Underpayments vendor

Every vendor in this category demos well. These are the questions that separate a product that will work on your volume, payer mix, and staff from one that works in the sales deck. Take them into the demo.

1. 1

   What underpayment recovery rate do you achieve, net of payer pushback?

2. 2

   How current are the contract terms and fee schedules your detection runs against?

3. 3

   Do you predict and prevent, or only detect after remittance?

4. 4

   What is the false-positive rate: how much staff time goes to variances that are not real?

5. 5

   Is pricing contingency on recovered dollars, and what is the rate?

6. 6

   How does your payer-side work (if any) create conflicts with our provider interests?

7. 7

   What claim volume do you need before the models perform?

8. 8

   Can findings feed our managed care team for the next negotiation?