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Frequently Asked Questions

How much administrative work will your auditing program cause for our health plan?

Very little. Other than intermittent claims transmissions and collecting your refunds, we will do the rest! And, with our optional collection services, we can help with that too!

How will our participating providers react to your audits?

Auditing has become such a standard in this compliance-conscious environment, that providers have come to expect it and readily cooperate. In fact, providers often express appreciation about our professional approach and expertise which provides learning opportunities for their coding departments.

How easy it is to recover our overpayments?

Our provider "sign-offs" enable hassle- free refunds, whether by electronic offset (which is often preferred by providers,) or by refund request. We also take the extra step of notifying the hospital’s billing office to expect the refund request, and obtain any special instructions or contact information that will facilitate the recovery.

What if a provider disagrees with your coding change recommendations?

Providers readily sign off their agreement to over 95% of our submissions. In a small percentage of cases, the provider will provide additional documentation that supports their original DRG assignment. In the rare cases where we are unable to obtain an agreement after additional attempts to re-explain our rationale to the hospital, we will provide you with our documented recommendations so that you can decide if you would like to proceed further without a sign-off.

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