Post-Payment Clinical Audits
Identify waste and abuse while protecting provider relationships
Identify losses and recover funds
Healthcare bills for non-contracted services, duplicate charges, incorrect Diagnosis Related Groups (DRGs) and other codes, and more complicated billing practices create significant financial and compliance risks for your organization.
Our Post-Payment Clinical Audits analyze healthcare claims to detect and correct billing errors, helping to identify excess waste from your overall claims spend and recover overpayments. Using proprietary audit and data mining algorithms combined with expert clinical reviewers, we accurately evaluate the cost and clinical appropriateness of charges after they’re paid, delivering timely turnarounds and a high rate of successful outcomes.
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Caring for providers during clinical audits
Clinical audits play a critical role in ensuring health plans’ financial health. Recognizing that these audits have the potential to cause provider abrasion, communication and education should be part of a health plan’s clinical audit program.
Ways we help
Technology
Our highly flexible proprietary system provides secure post-claims payment analysis, identifies erroneous claims and overpayments, spots Diagnosis Related Groups (DRGs) and other coding errors, and delivers custom reports.
Expertise
Our seasoned medical experts and clinical auditors know how to work with your provider networks and unique policies to increase positive outcomes and maintain healthy provider relationships.
Recovery
Our tools and people take the hassle out of finding billing discrepancies, saving you valuable time and offering greater recovery potential.
What you get with Post-Payment Clinical Audits
Trusted partner
We are with you every step of the auditing process—from claims analysis and review and provider communication to final recovery.
Provider sensitivity
Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.
Custom analyses
Our Post-Payment Clinical Audits support a variety of services and claims types according to your plan’s specific provider contracts to maximize efficiencies and recoveries.
Our Post-Payment Clinical Audits improve the identification and recovery of claims overpaid due to incorrect Diagnosis Related Groups (DRGs) and other issues.
Your Post-Payment Clinical Audits partner
Recover and restore value to get the revenue you deserve and make healthcare more affordable.
Prevent
Minimize future billing
errors with process updates
Correct
Detect and deter overpaid claims
and improper bills
Recover
Increase compliance and
financial performance
Related Post-Payment Clinical Audits resources
Contact us today for more information on accelerating your Post-Payment Clinical Audits results.