In Financial Review/Audit projects, our national team of audit and reimbursement specialists target and identify inappropriate, duplicate, and excess billing that results in credit balances and overpayments to providers. Financial review staff leverage our clinical staff as necessary
The Broad Spectrum of Credit Balance Recovery
The success of HMS’s Credit Balance Recovery stems from an innovative approach that integrates all overpayment identification and recovery processes into a single solution. Most vendors or processes focus on one aspect of Program Integrity (PI), such as subrogation, fraud and abuse, or correct coding. HMS’s unique approach provides the full spectrum of overpayment identification services in a single integrated process.
Our approach minimizes gaps that can occur when multiple vendors are involved.
The HMS Credit Balance Solution
For our solution we review all aspects of the billing and reimbursement process:
- Provider audits
- Subrogation
- Medical record reviews
- Data mining
- Pharmacy audits
Data-sharing across various PI components helps HMS accelerate cash flow and deliver a major boost to our clients’ bottom lines.
Finding Root Causes
Most PI processes and vendors focus on maximizing overpayment identifications and recoveries. However, after recovery, they fail to take the next, critical step: leveraging the data and knowledge obtained to avoid future overpayments. HMS gets to the root causes of overpayments. We analyze the results, then share the information learned with stakeholders and providers, helping to prevent problems from recurring. An educated and knowledgeable provider billing community is the first and best line of defense in preventing overpayments.
Customization: HMS assigns auditors to those sites where they can achieve the greatest results for our clients—not just where we already have them in place. And we’re successful with this model: HMS has gained entry into 100% of the provider facilities we’ve approached to perform audits.
Technology: To stay at the forefront of the industry, HMS invests tens of millions annually in state-of-the-art technology to support our clients.
Provider Sensitivity: HMS understands the work our clients put into developing relationships with the provider community. Our approach entails ongoing collaboration with providers—while ensuring the integrity of results. Providers who are being audited receive continual support, visibility into our findings, and recommendations for process enhancements.
Why We’re Unique
Experience: HMS has more than 25 years of experience providing healthcare cost containment solutions, including credit balance audits. We recover over $1 billion in overpayments every year for our clients.
Trust: We serve only payors of healthcare. Our business model avoids conflicts of interest, so we can deliver the full complement of overpayment services and maintain the trust of our clients.
Integrity: HMS is always ethical in dealing with clients, employees, investors, and all stakeholders in the healthcare delivery process. We never compromise on integrity. As a publicly traded company, we practice transparency in all our dealings, and aim for honesty and excellence in all our work. And when it comes to compliance and security, we are steadfast in our commitment to protecting healthcare data.
In a recent head-to-head comparison performed by the State of Indiana, HMS identified 3 times as many insurance policies as the next best vendor and 6 times as many active policies as the next vendor. And we were able to do so with 95% accuracy.
