Phone:
203-221-2716
Our auditors
work in every state every day generating refund checks.
191 Post Road West
Westport, CT 06880
Cost Containment
HOSPITAL BILL AUDIT
Hospital claims remain the health insurer’s largest expenditures.
Our clinical auditors have decades of experience and a proven record of consistent savings. A PHS audit compares the bill line by line with the medical record and verifies charges. The audit uncovers data entry or pricing errors, unbundling, inappropriate, unsubstantiated or improper charges, and other practices that inflate charges. With our historical database we can forecast audit returns at a given hospital.
DRG AUDIT
Diagnosis Related Groups were designed to reduce costs. However, experience shows that DRG overcharges inflate bills by about 15%. DRG up-coding can only be contained by professional review. DRG claims are reviewed by a physician familiar with the medical facts as well as an experienced coder. Our proprietary DRG sorting software is capable of handling thousands of claims and picking those with a high likelihood of savings. This enables PHS to audit large numbers of DRG claims on a non-random basis and has resulted in improved audit results.
HOME INFUSION AUDIT
The concept originated as a service to deliver IV pharmaceutical services in the out-patient setting rather than a hospital, with the intent of generating savings that would accrue to the insurer. What happened instead was the creation of a largely unregulated stream of claims slipping under the radar of most payers. PHS knows this industry and can produce
truly remarkable levels of savings for our clients.
COMPLIANCE AUDIT
Third Party Administrators and Pharmacy Benefits
Managers work under stringent time constraints. At the
same time it is your money, not theirs. The fiduciary
responsibility of seeing that claims are paid
properly is yours. Let our experienced
auditors assure TPA's are in compliance.
Call for your FREE Brochure today!
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