Credit Balance Audit

Pain Relief for Your Recoveries

How do you find out if an overpayment was made to a provider? At HMS we can help, delivering increased savings through a credit balance audit. We help ensure provider’s books are current and accurate so they can focus on other important initiatives and that overpayments are appropriately returned to payers.

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.

Most vendors focus on one area of payment integrity, such as subrogation or fraud or correct coding. HMS does much more. We cover all aspects of the process: from bill audit to claim review, getting to the root causes of overpayments.

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 provider’s 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 tackle credit balances, the resources required to resolve these accounts can be daunting. It is nearly impossible for providers to have the required resources to tackle this job.

That’s where 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’s 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. Since 2009, we’ve identified more than $300 million in overpayments, and have saved providers millions of dollars as a result of placing resources to better use. Our credit balance staff remains well versed in client reimbursement methodology and current billing policy changes to better equip themselves to identify trends and nuances while conducting reviews, and to assist with provider education.

Contact us today to learn how an HMS credit balance audit can relieve your pain.

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