Services We Provide

Health Compliance Associates specializes in paid claims audits and chart audits for
medical claims.  Our services can be broadly classified as:

Paid claims audit

Medical record/ patient chart audits

Charge master rate increase audits

How Health Compliance Works

Paid claims reviews serve as compliance audits because Health Compliance
identifies overbillings by applying not only the terms of the payer/provider
agreement, but also the Medicare Conditions of Participation and the respective
State Health Department requirements.

Health Compliance understands that overbilling patterns vary within hospital
departments, such as radiology and nuclear medicine, among hospitals in the
same network, and among networks in different regions.
A major reason for erroneous hospital bills is the more than 10,000 different items
in each hospital’s charge master.  There is almost infinite variability in hospital
billing practices.

Health Compliance reviews 100% of the client’s paid claims and applies
proprietary algorithms to identify potentially erroneously billed claims.  

Health Compliance reviews documents supporting the submitted claim such as the
medical record and the detailed bill.