Our Services
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SERVICES:
HOSPITAL BILL REVIEW / REVENUE RECOVERY
The review of hospital bills (inpatient and outpatient) is performed to determine the accuracy of charges appearing on the bill. IHAS' trained auditors perform on-site reviews of hospital bills to determine if all billed services/procedures were actually provided. All undocumented charges and overcharges are reported to the client. A SIGNED AGREEMENT from the hospital representative, which documents the hospital's agreement with IHAS' findings, is provided to the client as appropriate. CPT code validation also falls within this category of services. Revenue Recovery Services are applicable to Medicare, Medicaid and Commercial Insurance Programs.
UTILIZATION REVIEW
This service line includes a retrospective and concurrent review of inpatient hospital stays, and outpatient procedures to provide an opinion regarding the necessity and/or appropriateness of care provided to the patient. Pre-admission/pre-certification and second surgical opinion services are also provided. Physician approved medical criteria are applied. These services are applicable to Medicare, Medicaid and Commercial Insurance Programs.
QUALITY ASSURANCE REVIEWS
IHAS' QA process involves a review of provider procedures to make a determination regarding the quality of care delivered with regard to acceptable standards of care. Physician approved medical criteria are applied. This includes medical records review services in support of NCQA and HEDIS data collection requirements. These services are applicable to Medicare, Medicaid and Commercial Insurance Programs.
CASE MANAGEMENT
IHAS Registered Nurses and licensed Social Workers, as appropriate, assess and evaluate the progress of medical treatment and service coordination. Any required medical treatment is monitored and/or coordinated by nurses ,and/or Social Workers. Our Case Management staff acts as a liaison between the patient and the rest of the medical community. Our Case Managers coordinate services, assess needs, evaluate outcomes and look at the social issues involved with the patient's care. These services are applicable to Medicare, Medicaid and Commercial Insurance Programs.