As payers look deeper for opportunities to manage their medical costs, another area yielding savings is the actual comparison of the medical record to the hospital bill, in those cases where reimbursement has occurred on a percent-of-charge basis. In many instances, this comparison reveals such billing errors as services not delivered, multiple billing for the same item, unbundling of charges, mathematical errors and data entry errors.

HCA is a post-payment service capable of reviewing medical claims before or after provider payment. The analysis compares physician orders to billed charges. All hospital bill auditors have acute-care nursing experience and are successful on 80+ percent of cases.

How it Works

Claims with a high probability of error are identified using claim-specific criteria and historical review results; they are then forwarded to a nurse auditor. The auditor performs a thorough line-by-line review of the entire hospital bill to ensure reimbursement is based on actual services rendered to the patient. Auditors can perform reviews on or off-site. However, off-site desk audits may be performed at the hospital's request. Upon completion, review results and revised charges are confirmed with a signed agreement from the hospital representative.