We average a 15% reduction from annual billed charges by removing invalid and non-compliant charges prior to the application of a network contract.
Our review is performed by clinicians and coding experts with advanced certifications and degrees. We identify errors and non-compliant charges per federal, state and commercially accepted billing guidelines. We review claims for medical necessity and offer legal reviews regarding adherence to PPO contracts and plan documents. The end results of your partnership with HPC are Clean Claims that adhere to your Plan Docs and PPO contracts. This results in an overall reduction in plan cost through the reduction of errors.
Specifically, we look for items that are non-compliant with the following:
- Social Security Act
- Code of Federal Regulations
- Uniform Billing Act
- False Claims Act
- CMS Manuals
- State Laws
- National AMA and AHA Rules & Guidelines
CASE STUDY: $260k Savings on Double Lung Transplant
An eight-year-old child received a double lung transplant. The total claim was billed at $1,200,000…
CASE STUDY: 56-year-old male with rotator cuff tear
A 56-year-old male was treated for an unspecified rotator cuff tear/ shoulder rupture that was…