Rural Hospital Recovers $1.5 Million in Underpayments with Contract Management

As a rural community hospital, Bayou Bend Health System faces many of the same challenges confronting healthcare organizations across the country: limited resources, lean staffing models, and increasing complexity in payer reimbursement. With teams balancing multiple responsibilities, conducting comprehensive payment reviews manually can be difficult, leaving organizations reliant on spot audits rather than a complete view of payer performance.

As payer contracts became increasingly complex, identifying underpayments became both more challenging and more critical. Moving forward with upcoming changes planned for Medicaid and ACA eligibility, proper reimbursement for those insured is one of the highest priorities for smaller hospitals who operate on already tight margins.

Bayou Bend needed a more effective way to ensure reimbursements matched contracted rates without adding additional staff or increasing administrative burden. Historically, the organization manually reviewed a sample of payments—approximately 10 percent—meaning the majority of claims were never audited for accuracy.
Without a comprehensive view of reimbursement activity, identifying recurring payer issues and contract compliance was difficult. The team needed better visibility into payment trends and variances to protect revenue.

For rural hospitals operating on tight margins, every dollar counts. Ensuring accurate reimbursement is critical to maintaining financial stability and continuing to serve their communities.

By implementing a system that consistently compares actual payments against contracts, and not rely on period manual spot checks, the team was able to compare actual payments against contracted reimbursement rates across all claims. Using TruBridge Contract Management, the team uncovered a recurring pattern of underpayments tied to outdated reimbursement rates from one specific payer due to the consistent variances highlighted by the system.

With detailed reporting and clear visibility into payer trends, the team was able to document the discrepancies, quantify the financial impact, and provide compelling evidence throughout the [RD5.1]resolution process. Armed with data from Contract Management, Bayou Bend successfully escalated the issue and ultimately recovered approximately $1.5 million in owed reimbursement.

This approach not only helped resolve a significant underpayment issue but also gave the organization greater confidence that reimbursements were aligned with contract terms and that potential variances could be identified before they became larger financial challenges.

Bayou Bend spent nearly 11 months working to resolve the issue, escalating concerns through appropriate channels and ultimately involving the state insurance commissioner.

• Approximately $1.5 million in recovered reimbursement that rightfully belonged to the health system
• Improved reimbursement oversight and trend analysis
• Enabled more efficient auditing and payment review processes