Audit Services
Audits of healthcare claims for overpayments are increasing as both public and private sector payers try and contain runaway healthcare costs.
With ConVergence Point, payers have a data-driven tool to perform audits in an efficient and transparent manner but, more importantly, a tool to correct processes on the front end to greatly remove the need for the audits.
ConVergence Point Audit & Recovery Highlights:
- An open, impartial and transparent tool with rules that are well documented from national sources such as CMS and the AMA — available to payer staff and providers alike
- An efficient, automated audit process that just as easily find $10 of savings on a $100 claim as finding $1,000 on a $10,000 claim
- Provider outreach tools: Bloodhound provides a sophisticated suite of reports and analytics available as an outreach program that assist providers in understanding the basis of their overpayments
- Verifiable return on investment — Bloodhound provides a suite of reports that address project value and clearly demonstrate successes
- Temporal Edits: For audits to be fair and effective, edits must be applied based on the Date of Service, not the date of the audit.
The End of Recovery — The Real Strategy:
Audit and recovery programs exist because miscoded, duplicate, or otherwise incorrect claims are paid. Bloodhound believes that the best strategy for payers is a one-time audit and recovery program combined with an effective prospective clinical editing program.