Similar to other companies that perform managed care audits, Auditech will review both inpatient and outpatient accounts to determine if they were paid correctly based on the contracted rates. One of the unique aspects of Auditech is that we are able to utilize our knowledge of billing and coding to determine if there are other opportunities for additional recovery.

For example, at one hospital, we noticed that although they had a hospital rate for Transitional Care there was no provision in the contract for payment for that type of bed. The insurance company would continually pay the medical-surgical rate as it was not an intensive care day and there was no rate for Transitional Care.

Based our review we determined that if the hospital had a Transitional Care rate they would have been paid an additional $500,000 based on other contracted rates with other payers. After identifying this to the hospital, they made the necessary changes in a contract the following year and are continuing to realize the additional cash flow as a result.

The same type of thing applies to transplants. Transplants are typically handled in three segments. There is the pre-transplant; the actual transplant and a certain follow-up period following the transplant. It is important to be able to discern how each individual segment is paid in ensure that the payment is correct. Often times, the follow up period may be in a stop loss position; however, it is paid at a per diem rate or some other rate.

At Auditech we are well aware of the variations and nuances of provider contracts and how they should be administered. There are dozens of ways in which either the billings or the contract interpretation lead to underpayments. It is our goal to compliantly review all of your claims against the contracts to ensure that you were paid correctly.

 


Please contact us if you have additional questions or to learn more.

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