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Phone:
203-221-2716
Savings opportunities are hidden in your claims info.
We recover those savings!
191 Post Road West
Westport, CT 06880
| Case #1 - HOSPITAL BILL AUDIT ($159,593) |
A $1.3M hospital bill was declined for audit when the client’s regular auditor asked them to pay the hospital audit fee of $13,000. They decided to give PHS a try. We avoided the hospitalīs (outrageous) audit fee and reviewed 6 separate hospitalizations. We found $166,992.54 in inappropriate and incorrect charges that resulted in checks returned to the client (after their discount) totaling $142,062.88. Then we reviewed physician charges and recovered an additional $17,530.66 of incorrectly paid charges.
Total savings: $159,593.54 (12.3%) |
| Case #2 - DRG Audit ($12+ MILLION) |
An east coast HMO wanted an audit of DRG claims at several
metropolitan area hospitals going back 12 months. We performed
an audit of several thousand DRG claims that included adjudication to technically complex contract language, clinical review and validation of
all ICD-9 codes and DRG grouper methodology. We discovered that in addition to significant clinical coding errors many of the claims had
been paid incorrectly per the contract. The savings was so large that it
resulted in a negotiated settlement and advantageous contract
language resulting in future savings.
Total savings: MORE THAN $12 MILLION |
| Case #3 - Home Infusion Audit ($112,159) |
A TPA in the Midwest asked us to review billings for physician office based IV (chemotherapy) treatment for cancer. They had already paid $179,756.00 for 6 separate episodes of chemotherapy. As a direct result of our review the physician practice sent a check back to our client.
Total savings: $112,159.00 (62.4%) |
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