| PPS has been performing Managed Care Compliance
Audits since 1991, and today, PPS creates managed care audits that deliver bottom
line results in a short period of time by first identifying areas where existing
contracts have not been fully paid. And then, PPS works with the payer to have
the appropriate amounts released directly to your facility. However, while having
managed care contracts perform as they were originally drafted is a primary concern,
a longer term rationale is embraced by many of our clients.
Specifically, periodic managed care audits provide data for trend identification
of reimbursement types and payers. This information is vital for hospital financial
executives and administrators as they design new internal procedures to capture
more reimbursement. Additionally, the data is extremely helpful when negotiating
contracts with payers.
PPS reviews three-month cycles of managed care reimbursement activity based
on data provided to PPS by the facility’s IT department. PPS has an internal
staff of IT professionals, with deep experience across major software packages
employed by healthcare institutions, and in most cases, your IT people will not
have to manipulate the files. We use proprietary software that we have developed
over the last 18 years to perform the initial analysis.
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The PPS Managed Care Compliance
Audit Process
- Audit
- Documentation/Research
- Appeal
- Resolution with Payers
- Payment
With a quick start up time, the audits are low impact
on your staff and internal resources as they are conducted offsite and require
no reprogramming. During this process, PPS will issue interim reports, apprising
you on the progression of our work.
All re-captured revenue from payers is paid directly to your facility, based
on PPS findings and after our negotiations with your payers. PPS manages all follow-up
activities with payers on your behalf, while updating you periodically on the
progress of the audit and recovery process. Compensation for PPS services may
be made on a flat fee basis or on a contingency one – it’s your choice
because PPS is a service-oriented partner for you. The revenue improvements are
immediate and direct because re-captured revenues flow directly to the bottom
line since all costs have previously been expensed.
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