Pricing & Reimbursement Strategy

In today’s reimbursement landscape, denials and audits are more than occasional obstacles, they’re routine challenges that require specialized expertise to resolve.

At Compass Revenue Solutions, we offer a dedicated Appeals and Audit Strategy service designed to protect your revenue, overturn unjust denials, and proactively manage audit risk. Our team builds customized responses rooted in payer policy, clinical documentation, and federal protections like ERISA. 

At Compass Revenue Solutions, our behavioral health billing experts work on behalf of your company to expedite billing and effectively process claims to increase your review. 

Turning Denials into Dollars 

Every denied claim is a missed opportunity to capture earned revenue often due to coding discrepancies, lack of documentation, or misinterpretation of medical necessity. Our appeals specialists understand payer behavior and regulatory language, enabling us to craft effective rebuttals. Whether dealing with commercial carriers, Medicaid, or government audits, we fight for fair reimbursement on your behalf. 

We analyze trends and develop a proactive audit strategy that aligns with your clinical model and payer mix. 

Our Appeals and Audit Services

Compass Revenue Solutions offers full-service support for both post-payment audits and claims denied, including: 

• Formal appeal letter drafting with payer-specific language 

• Medical necessity justifications tied to ASAM, DSM-5, or LOCUS criteria 

• Submission of ERISA-based appeals for self-funded plans 

• Coordination with clinical teams for supplemental documentation 

• Peer-to-peer review support and escalation 

• Audit defense preparation and response strategies 

The Compass Process 

We start by categorizing denials to identify systemic issues (e.g., authorization errors, documentation gaps). Each case is then assigned to our dedicated team with specific payer or service line expertise. Appeals are submitted timely and tracked through resolution, with frequent updates and outcome metrics shared with your leadership. 

For audits, we prepare structured response packets that clearly outline the medical necessity of treatment, with supporting documentation and compliant formatting to reduce repayment demands and protect your facility. 

Benefits of Utilizing Compass Revenue Solutions 

Increased Reimbursement: We overturn denials and recover lost revenue that others write off.

Reduced Risk Exposure: Proactive audit defense strategies minimize penalties and repayment demands. 

Payer Expertise: Our team understands the nuances of behavioral health billing and insurer tactics. 

Appeal Success Tracking: We provide analytics on success rates, denial trends, and overturn metrics. 

Don’t leave money on the table or face audits alone. Let us handle the defense.