WHO SHOULD USE THIS SERVICE
Hospital Bill Audit (HBA) services work best for plans that reimburse facility claims by a fee-for service methodology. For example, reimbursements made at billed charges or on a percent off charge basis.
PROCESS FOR EVALUATION OF CLIENT'S CLAIM
HealthMind has achieved an overall National Identified Savings Statistic of 3.63% of billed charges. Savings is a net calculation defined as overcharges minus under-or-unbilled charges. We have also developed a national database of error rates and resultant savings for many facilities in the United States.
HealthMind will evaluate your facility claims for a six-month period of paid claims data to evaluate whether your specific providers are those in which we have had successful experience with our HBA program. While this analysis cannot predict the precise savings since the audit will not actually be performed, the analysis does provide valuable insight as to whether your company is significantly overpaying these claims, and whether the audit program would produce meaningful savings.
HealthMind will also work with your company to gain an understanding of your facility contracts to determine, in conjunction with our provider statistics database, the best potential implementation strategy and which hospitals would be earmarked for a pre-payment off-site audit (Desk Audit) versus a post-payment on-site audit. HealthMind will also validate that your company’s particular business mix, including states and provider for auditing, contract versus non-contracted ratios as well as special contract conditions like per diems and carve outs, provide a sound basis for proceeding with the HBA program.
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