Software

Audit & Recovery

A payment integrity solution for payers that want to maximize overpayment recovery, reduce improper payment waste, and promote provider satisfaction.

 

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Our OverpaymentAudit and Recovery Services

  • Maximize overpayment recoveries by leveraging our coding and claim expertise and extensive clinical and pharmaceutical knowledge to recover lost dollars due to improper payments.

  • Drive efficiency with automation tools tailored to your reimbursement policies and methodologies.

  • Maintain provider satisfaction, working collaboratively with providers to obtain their sign-off on payment recoveries on claim audits while promoting maximum recoveries.
  • Reduce losses with the oversight required to combat improper payments in a complex healthcare environment.

  • Integrate seamlessly with existing workflows so you can help maximize savings without interrupting current processes.

  • Mitigate future risk and exposure with the ability to address a full spectrum of claim types.

Deliver Clear and Concise Audit Rationale

  • Diversified audit portfolio

    • Select from several audits including DRG, Hospital Charge, Hospital Billing Validation, Contractual Carve Out Recovery, and Contract Compliance to verify diagnosis and procedure codes, services rendered, and improper payments.
    • Support sequencing in accordance with national coding standards, perform clinical review, and use powerful data analysis and screening to compare to policy and contractual terms.
    • Review complex medical records and control rising costs associated with reimbursement and help minimize provider appeals.

  • Provider-friendly flexible approach

    • Leverage a customizable audit program tailored to specific payer reimbursement policies to help produce optimal results.
    • Access to a web portal, and ability to request on-site, or remote audits.
    • Obtain a signed agreement from the facility or provider verifying acceptance of the audit.

  • Experienced audit professionals

    • Take advantage our audit team’s exceptional level of audit expertise, professionalism, and accuracy.
    • Have confidence in our 20+ years of delivering accurate audits with concise and defensible audit rationale in over 6,500 US hospitals.
    • Depend on our staff auditors who average 15 years of coding experience, are each AHIMA certified, and undergo quarterly quality assurance reviews with strict adherence to national coding guidelines.

Our outcomes

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Infographic

eRemit and National Payments Connector™

Infographic

eRemit and National Payments Connector™

Discover how electronic EOPs, ERAs, and payments can eliminate paper to save you time and money.

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Case Study

Coordination of Benefits Services Help Health Plan

Case Study

Coordination of Benefits Services Help Health Plan

Discover how a regional carrier generated 250%+ ROI and increased yearly collections by $500,000 with comprehensive coordination of benefits (COB) solutions.

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On-demand Webinar

Elevating Your Approach to Patient Communications

On-demand Webinar

Elevating Your Approach to Patient Communications

Learn how an enhanced communications strategy can improve financial performance while simultaneously boosting patient loyalty and trust.

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