What is an Audit?
What is an Accu-Rate Hospital Bill Audit?
Most hospital bills are paid from a summary bill, referred to as a "UB-92." This brief invoice lists charges by department only (Radiology, Operating Room, Pharmacy, etc.). It is impossible to verify the accuracy of a summary bill, because it does not provide an itemized list of charges within each department.
The hospital also generates a detailed, itemized bill, which is the basis for each summary bill. The itemized bill may contain as many as 700 separate line item expenses, which are summarized in a UB-92.
The payers of hospital bills (Third Party Administrators, insurance companies, etc.) rarely see their clients' itemized bills. As a result, billing errors often slip through the system, undetected.
Accu-Rate's professional hospital bill auditors review the client's summary bills, then scrutinize every single charge on the detailed, itemized bill. By reconciling the UB-92 and the detailed bill, our auditors are able to identify discrepancies and overcharges.
Our auditors find the answers to a wide variety of questions, including,
1. Has this product or service actually been provided?
We find that some charges are for products and services that have not been provided at all. In one case, we found that a hospital had billed a patient for medications he had allegedly received, after his death and cremation.
2. Has the produce or service actually been provided to this patient?
Some hospital charges may be posted to the wrong patient's bill. For example, we have seen neonatal charges on the bill of an adult male patient. If costs are moved deliberately (e.g., from the bill of an uninsured patient to the bill of an insured patient), the process is known as "cost shifting."
This type of billing error may be difficult to identify. Often the "shifted" items are priced and coded correctly, but charged to the wrong patient.
3. Have charges been bundled and unbundled?
Various charges may be consolidated or "bundled" together (for example, "Room Charges"). In some cases, the hospital bills the patient for the bundled items and for each individual item. This form of double-billing is known as "unbundling."
4. Are the products and services coded correctly?
Each item on the hospital bill is assigned a code. Often a patient is charged for a more expensive procedure than was actually provided (a practice known as "upcoding"). Of course, this results in excessive billing. Accu-Rate's auditors make sure that each item is coded correctly.
5. Is the hospital's pricing consistent with "Usual, Customary and Routine" (UCR) rates?
Our auditors may find that a hospital has inflated its prices (often by 300%-400%), before applying the negotiated "discount." For example, we have seen a hospital charge over $39 for a vitamin with a UCR of six cents.
Accu-Rate serves as your advocate. Our nursing, coding, and investigative personnel consistently identify overcharges of 10% to 15% per bill (Computerized audit programs generally identify overcharges of 2% to 3%).
After our auditors complete their analysis, we work with providers to clarify discrepancies and eliminate overcharges.
Finally, we send the employer a report of the savings generated by our audit. Such reports include dollar figures only. Employees' medical information is maintained in strict confidence and is not shared with anyone.
You have no risk! We are compensated with a portion of the credits and/or adjustments that we provide to our clients. You pay nothing unless we are successful in reducing your healthcare costs. Your only investment will be (a) any copy fees charged by doctors ad hospitals, (b) the air courier fees required to send bills to our office, and (c) a small retainer, which will be applied toward savings achieved by Accu-Rate.