What We Offer
Health care providers are expected to submit claims for services compliant with federal and state standards including any contractual requirements. Due to the complexity and size of each hospital’s retail price list, submitted claims are regularly not compliant with these standards resulting in generally unanticipated and unknown overpayments.
Health Compliance Associates audits paid claims and frequently the medical record, identifies non-compliant overpayments, determines the reason for the overbilled claim and typically recommends auto-recoupment of the overpaid claim. As a billing compliance company, Health Compliance Associates is itself compliant with all regulatory standards including HIPAA.
- Paid claims audit
- Medical record & patient chart audits
- Charge master rate increase audits
To date, over $60 million has been identified and returned to payers. Since the overpayments are non-compliant overpayments, not one provider has complained about returning the overpayments.
Regardless of the number of previous audits of the same claim set as provided to Health Compliance Associates and depending on the financial class e.g. government, commercial, case rate, percent of charge, Health Compliance Associates identifies typically for auto-recoupment between .25% to 8% of total facility claims.