Credit Balance Audit

Delivering increased savings and payment accuracy.

Contact Us

HMS helps payers identify and recover overpayments, while helping providers ensure their books are current and accurate.

While your focus remains on your business, HMS can concentrate on identifying, tracking, and pursuing recovery of overpaid funds. That’s why we back up our best-in-class credit balance
audit with a comprehensive payment accuracy program.

Through onsite, desk/remote, and provider self-disclosure methods for both health plan and government entities, we can boost overpayment recoveries.
HMS has the only truly comprehensive solution in the market that delivers the best overpayment identification and recovery results.

Let us help you:

  • Identify the root cause of credit balances so they won’t recur
  • Reduce the burden of providers managing credits
  • Allow providers to allocate resources to areas that bring money in as opposed to sending
    money out
  • Stay up-to-date on the reimbursement methodologies of various payers
    Return overpayments to payers

The impact of credit balances is surprisingly large. For example, a small-to-medium size hospital with annual revenues of $100 million may generate $2 million in new credit balances each year.
Multiply that by nearly 6,000 hospitals nationwide, and we’re looking at more than $8 billion in estimated new credit balances a year.

Since many hospitals manually handle credit balances manually, the people required to resolve these accounts can be daunting. It is nearly impossible for providers to have the required resources to tackle this job.

HMS Can Help
We get to the root causes of overpayments, analyze the results and share our insights. Then, with education about our findings, we can help providers prevent credit balance problems from recurring.

HMS’ flexible process can be tailored to suit almost any situation. Auditors are available to visit provider facilities on a weekly, monthly, bi-annual, or annual basis, depending on need. If space
is an issue at a facility, HMS can also assist via remote access.

We’ve always been at the forefront of healthcare, delivering new and fresh approaches to cost containment for payers and providers. We give our provider service analysts extensive refund methodology training. This helps support providers and payers so that accounts are adjudicated quickly and accurately. Our complex credit balance financial review process includes a full review of multiple aspects of a provider’s patient A/R system and process.

Additionally, through our data analysis process, HMS can target potential overpayments that do not typically appear on a provider’s Credit Balance Aged Trial Balance (ATB) report. While conducting credit balance financial reviews, our knowledgeable staff are able to identify trends and anomalies with billing and/or reimbursement that might otherwise go undetected. Suspect cases are researched, results vetted, and then identified issues communicated to the provider and/or client for remedial action.

We electronically record all identified improper payments, scan all supporting documentation, and link it to the overpayment record in our system. Access to documentation can be provided to you via this web-based document storage system. All identified overpayments undergo review to ensure they do not duplicate other HMS provider recovery initiatives.

HMS understands the importance of maintaining strong, professional relationships with the provider community. Through collaboration, we help ensure the integrity of results. While undergoing an audit, we promise providers ongoing support, transparency into our findings, and recommendations for enhancing the process going forward.

HMS delivers overpayment recovery services to health plans and state and federal agencies. We’ve identified more than $300 million in overpayments and saved providers millions of dollars
by putting resources to better use.

Our credit balance team is well-versed in client methodology and billing policy changes. So we’re better at spotting trends while conducting reviews and able to assist with provider education.

Contact us today to learn how an HMS credit balance audit can identify your overpayments.

We’ve identified more than $300 million in overpayments and have saved providers millions of dollars by putting resources to better use.

Your Details

Please enter your details to access this resource.

Contact Us

Please fill out the boxes below.