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HoCAS - Hospital Claims Audit Solutions Overview
With in-depth government and healthcare experience, we understand that a sizeable amount of Claims contain errors. This can add up to significant monies erroneously paid due to data entry mistakes, carelessness, lack of coding knowledge or a deliberate attempt to increase reimbursement by Upcoding.

The Service Includes

• With the Hospital Claim form having 81 unique fields, the permutations of errors possible are immense. However, some of the errors/ combination of errors have minimal or no impact on reimbursement. We have worked with clients in identifying edits with highest historical rate / probability of error and those which relate to 'medical necessity' and those which have maximum monetary impact.
• Our audit solutions are designed to help healthcare payers reduce and ultimately prevent inappropriate payments. Through our data mining and RAC-like business rule engines we identify and track accuracy of payments. They are designed to pinpoint and reduce billing and coding errors, and fraud and abuse after medical claims have been paid
• We process live and historical claim data through our detection engine in order to identify services that don't comply with billing rules. Suspect claims that require additional review are also identified and reviewed.

• Identify and stop inappropriate practices and recover funds
• Meet state and federal regulations
• Avoid costly investments in analytical systems for identifying ‘rogue’ providers and suspect billing practices
• Strengthen  provider relations