Detect incorrect, duplicate, and inappropriate charges

This thorough post-payment hospital bill audit process identifies auditable claims and then verifies that billed services were ordered by the physician, rendered to the patient, and charged at appropriate rates. Discrepancies are identified, and overpayments are recovered for the health plan.

Ingenix hospital bill audit services help you:

• Identify potential discrepancies
• Validate billings
• Recover overpayments

Identify auditable claims

Ingenix imports and reviews paid claims data from the health plan, using detection software tools technology to identify appropriate claims for auditing. Standard inpatient hospital bill audit criteria include claims paid on a percentage of billed charges basis and those bills exceeding $25,000.

Validate coding and billing accuracy

Ingenix first sends a letter of intent to audit and requests an itemized bill, then reviews documents and identifies potential discrepancies to investigate at the facility. An auditor examines physician orders, itemized bills, and other records to validate coding and billing accuracy and document discrepancies before securing hospital sign off.

Detailed review by experienced professionals

Claims reviews are conducted by more than 200 trained field auditors, including experienced nurses and CPT® coding professionals. Ingenix auditors develop strong working relationships with facility auditors and other personnel, enabling quick access to necessary information.

Recover overpayments and report results

Ingenix keeps clients informed through each stage of the auditing process. Monthly activity reports communicate status of all audit cases and recovery efforts. Monthly performance reports detail projected and actual recovery results, turnaround metrics, and discrepancy and collection rates.