Is an audit the same as a Compliance Analysis?
Not Quite.
There are important differences to know about.
A compliance analysis requires a detailed review of the UB-04 in combination with the detailed itemized statement. It’s performed prior to payment and conducted in-house with easy access to supporting documentation. The errors identified are based on federal regulations and billing guidelines. A Compliance Analysis is performed in a short time frame to meet the restricted reimbursement guidelines imposed on payers. The vast majority of hospital billing errors and disputes can be identified and addressed with the Compliance Analysis process.
Hospital bill audits require a detailed review of all medical records (almost always in person), is costly and extremely time consuming. Most hospitals require a large percentage of the bill to be paid in advance of an audit, and the process ends in an agreement on-the-spot. The errors identified in an audit are based only on the question, “Was the service ordered and was it performed?”
Here’s how a Beacon HCI Compliance Analysis works for you and saves millions.
Compliance Analysis is a process that is most effectively accomplished on a pre-pay basis by combining our software forensics and nurse review. A forensic analysis is performed on each field of the summary bill, known as a UB04 claim form, and a forensic analysis on each line item of the detailed itemized statements breaking down each summary charge contained on the UB04. This analysis applies the federal compliance regulations and billing guidelines to each line item, identifying errors and flagging certain other line items for professional review.
This is what we refer to as getting the claim to be “True & Accurate” from the start.
These services can also be done on a post-pay basis, the goal is to save your group or client from over-paying and let them keep their money, rather than have to fight to get it back. That is why we always recommend doing this on a pre-pay or pre-adjudication basis.
As always, Beacon will provide you with a detailed report of all charges that are ineligible for reimbursement, available via our LumenEx platform - all before you have paid the bill. That means you and your team are empowered to pay only accurate charges from the get-go.
We can get you started with just a handful of claims and show you the savings.
