AI-Driven Revenue Recovery
Recover your hospital’s lost revenue by leveraging our custom AI-Driven Analytics Software. Our software allows for a quick and efficient recovery process.
The FactWise Advantage
Recover Lost Revenue
We are a leading, full-service healthcare technology firm specializing in Healthcare Claims Recovery. We leverage our experienced staff to create cost-effective healthcare solutions of uncompromising quality using proven AI-technology.
Zero Risk: Hassle-Free and No Upfront Costs
We are both contingency-based and performance-based. We offer a Zero Risk contract by ensuring a hassle-free process to process all claims and only get paid after we help you recover revenue.
Personalized Security
We are committed to providing true end-to-end total business integration solutions for Revenue Recovery to all ambulatory hospital systems. Our comprehensive Revenue Recovery software allows us to personalize our service for each and every hospital independently.
How It Works
FactWise optimizes reimbursement due to billing inconsistencies between the provider and the payer, targeting zero payments and underpayments. We will use your data to discover billing and claim patterns that are unique to your business and work with you to re-file your claims.
Our Process
Step 1: The hospital makes 835/837 claims available through a secure server.
Step 2: FactWise runs AI software.
- Sequences proper procedure codes.
- Identifies proper insurance carrier.
- Modifies quantity adjustments.
- Bundles procedures when necessary.
Step 3: FactWise generates reports for revenue deemed recoverable.
Step 4: FactWise assists hospitals in submitting amended claims based on comprehensive analysis.
Customer Case Study
Example of what we can do for you
Methodist Hospital Group Indiana
Our AI helped Methodist Hospitals in Indiana recover over $2.5 million in under 3 months.
$340 M Net Revenue and 3.4% EBITDA
2 Hospitals, 530 Beds, 13,700 IP Admissions, 67,700 ER Visits, and 98,000 OP Visits
- 2,100 Employees and 460 Physicians
Overcome These Obstacles
By Using RevQuest, you will overcome these Obstacles
Healthcare Claims Recovery
Recaptures lost revenue due to billing errors and inconsistencies, targeting zero payments and underpayments.
Chronic Care Managment
Focuses on finding inconsistencies and missing data to bill or rebill chronic care services.
Remote Patient Monitoring
Remote Patient Monitoring enables the monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which increases access to care and decreases healthcare delivery costs.
Potential Recovery Obstacles for Hospitals
- Limited staff and resources to focus on all issues.
- Complexities of denials and underpayments can make it difficult to determine a clear path for re-billing.
- Filtering of issues limits work on selected rebills
- Multiple small discrepancies over time may result in a large opportunity to recover revenue.
Did You Know?
Denying claims from commercial and government insurance is the primary way hospitals lose revenue, where 58% of all claims initially denied come from commercial insurance. Underpayments for Medicare and Medicaid were $76.6 billion in 2018, with two-thirds of all hospitals receiving less total Medicare payments than costs.