HOSPITAL BILL REVIEW / REVENUE RECOVERY
IHAS reviews hospital stays and physician services to advise clients (for instance, the Center for Medicare and Medicaid Services, State Medicaid agencies and HMOs) about the quality, necessity, appropriateness, and cost-effectiveness of care provided to patients. Reviewed results are compared with accepted medical standards to determine integrity and compliance.
IHAS personnel apply their skills also to managing the process of claims payment. Our detailed knowledge of usual and customary payment practices and guidelines enables us to identify savings prospectively and recommend retrospective cost-recovery steps.
The firm assigns registered nurses, certified coders or other health
professionals, as needed, to abstract medical records for computerized storage and analysis. IHAS’ healthcare auditing personnel perform on-site review of hospital bills to assure that all billed services were provided and accurately charged.
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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.
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COMPLIANCE REVIEW
IHAS and it’s highly trained staff of Nurses and Coders, assist Physicians and Hospitals in preparing and defending their practice against potential audits. Most recently, IHAS has been focusing its efforts on assisting practices in the preparation for upcoming RAC Audits.
RAC Audits are coming……. Is YOUR practice ready???
-Are you a Physician, providing services in the United States?
-Does your practice receive Medicare Payments?
If you answered YES to these two questions, YOUR PRACTICE COULD BE AUDITED!!
Auditors contracted by the Centers for Medicaid and Medicare Services (CMS) will begin RAC Audits in August 2009.
LET IHAS HELP YOU GET PREPARED!
The Centers for Medicaid and Medicare Services are gearing up for Nationwide RAC Audits that stand to take hundreds, if not thousands of dollars from your practice in overcharges.
IHAS knows your practice can’t stand to refund money in these tough times. And here’s how we can help!
Preparation for RAC Audits
IHAS and it’s highly trained staff of Nurses and Coders, will do an audit of your charts to determine where overcharges may be found by the RAC Auditors, and to identify undercharges that you may “re-bill.”
Defending of RAC
IHAS will be there, if your practice is audited to help defend against overcharges identified and to identify undercharges that you are due.
Don’t understand the RAC Audit Process? Concerned that your practice may be at risk? Just want to learn more?? Contact IHAS today for more information!
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.
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IHAS MEDICAL BILLING
We have the solution….and now so do you!
IHAS utilizes appropriately trained and/or certified medical billers to provide complete billing management which includes processing patient charges, distributing insurance payments, A/R management, sending & distributing patient statements and handling patient inquiries.
Medical Billing the IHAS way!
Experience
- 20 years of working with insurance companies, assisting with revenue recovery
- Experienced Medical Billers who are ready to save you money
- Key Staff are Members of American Medical Billing Association
- Certified as a Quality Improvement Organization
Complete Billing Management
- Processing Patient Charges
- Distributing Insurance Payments
- A/R Management
- Sending/Distributing Patient Statements
- Handling patient inquiries
State of the Art Software
- Online Access to your patient accounts
- HIPAA compliant
- Multiple office Support
- Professional Reports tailored to your specific practice needs
- Hourly Data Backups
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