“So many practices are bleeding revenue and don’t know it. Rivet not only stops the bleed, it heals your revenue from the inside out.”
Gabi Bingham has spent the last 30 years at Clearview Cancer Institute, holding practically every business job there is, including director of billing and reimbursement. Her key focus now is ensuring high dollar drugs are paid correctly. Bingham is the practice’s primary Rivet Payer Performance user since Clearview Cancer Institute began using Rivet in March 2024. The following is her experience using Rivet to recover payment from underpaid claims.
Clearview Cancer Institute was overwhelmed by spreadsheets, manual data entry, and detective work. Looking for trends in payment issues was clunky and lengthy endeavor.
Margins are thin; that’s why revenue for high-dollar drug claims is Gabi Binghham's key focus as a revenue analyst at Clearview Cancer Institute. They needed a standardized procedure and software to help her practice catch underpayments.
“Drug margins are at 6%. If we’re not capturing revenue for everything we do, we’re bleeding revenue,” Bingham said.
As revenue analyst, Bingham discovers payment issues and goes back to the team with solutions — something Bingham says isn’t possible without the right tech to make it happen. And that's where, Bingham says, Rivet comes in.
“Payers automatically adjust claims, and it’s not easy to track on your own. We needed a quicker solution to determine what the issues were and how to solve them. That’s why we needed Rivet,” said Bingham.
Bingham continued: “We are able to uncover payments that are correct based on prior authorization, not the claim. With Rivet, we are able to fix prior authorizations and get paid for the amount of treatment that was actually issued.
“Rivet allows me to easily prove that prior authorization is keeping us from proper payment — streamlining collaboration with the prior authorization and billing teams to right-size prior auth so we aren’t leaving any money on the table. And it adds up quickly — we’re talking tens of thousands of dollars per patient. Rivet paid for itself tenfold.”
Bingham found these underpayments through Rivet's Payer Performance tools.
“I can clean up the claim view for high-level outlooks and then delve deeper into sets of claims or even individual claims without any real work. It’s a few clicks in and a few clicks out. It’s very simple and easy to use.”
Bingham was surprised to find that prior authorization underpayments were not Clearview's only underpaid claims. She also found that she could find where insurance companies hadn't updated fee schedules per contractual escalation year-over-year.
“With Rivet, I caught escalators that should’ve paid out more this year. I was able to know what was supposed to change and push payers to be accountable."
But that's not all.
"Not only that," Bingham continued, "I was able to call out payment terms that were unfavorable and we’re working to negotiate because of Rivet’s comparison tools. We have two main payers — Medicare and BCBS of Alabama — so more money is written off because we simply do not have leverage without Rivet.”
Bingham said Clearview loves Rivet for many reasons, but the largest reason is Rivet's impact on revenue.
“So many practices are bleeding revenue and don’t know it. Rivet not only stops the bleed, it heals your revenue from the inside out.”
Learn more about Rivet's robust underpayment and payer performance tool now: Schedule a Rivet demo