Bill Audit

Less Aggravation, More Recoveries

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Medical bills submitted to you, by providers, can be incorrect for any number of reasons. Finding the errors can be both resource- and labor-intensive.

Approximately 85% of all the claims HMS reviews have a net finding in favor of you, the payer. These reviews will, on average, return 3% to 7% of the total amount spent on claims annually to you through focused bill reviews. Let an HMS Bill Audit do the heavy lifting for you.

HMS has a national team of highly skilled registered nurses that can identify unnecessary spending of your valued healthcare dollars. They ensure that what is submitted to you on a bill is accurately reflected as being provided in the medical record, ordered by the physician, and is appropriately billed for per federal, state, and your contracted billing guidelines.

Our nurses are trained β€” and in most cases certified β€” through the American Association of Medical Audit Specialists to identify billing errors commonly found in treatment settings and service codes. We possess the necessary tools, technology, and auditing team so you can focus on your network and plan.

How much could you recover? One hospital miscalculated the amount to bill for a single heart drug β€” 750 times. Our system zeroed in on the error, allowing the payer to recover more than $220,000.

In another case, we identified a particular procedure was billed 165 times, instead of once as it should have been. This resulted in a net recovery of $406,000 from this provider on an $805,000 bill.

It’s true, not all cases have these types of findings. In approximately 15% of the cases reviewed at HMS there is either no findings or net undercharges. But with a vast majority of claims favoring the payer, it just makes good business sense to conduct a Bill Audit through HMS.

Over the years, our well-known and respected tenured nurses and staff have built solid relationships with the providers we review. This is a position of trust we appreciate, allowing for a smooth process and education, which minimizes appeals and curbs abrasion.

Bill Audits are one of the most efficient ways of ensuring providers receive accurate payments based upon focused reviews of services.

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