Audit and Review Services – Provider and Payer

InfiniteBPO provides detailed and comprehensive compliance review programs for Hospitals, both Inpatient and Outpatient facilities, Physician Practices, and for Payers. These programs are tailored to the needs of each individual facility and focus on review and support.

Provider Audit and Review Services:

• In-depth analysis of billing and reporting procedures
• Inpatient (DRG Compliance Review)
• Outpatient (APC Compliance Review)
• PRO and Payer Denial Reviews
• Credit Balancing
• Prepares and submits the documentation required to support a retroactive medicare rate adjustment
• Coding compliance auditing services
• Professional compliance auditing services
  • Utilization review services and Risk Management Projects & Case Studies.
  • Provider-specific audits (benefit specific), comprehensive of a provider’s complete practice
  • Resource-based relative value scale provider fee schedule
  • Audits to assure correct process is followed for determining network discounts and allowances for out-of-state providers
  • Audits to determine that the correct network is utilized for out-of-state provides
  • Audits to determine timeliness of claims payment and other provider satisfaction issues

Payer Audit and Review Services:

• Cost Containment Audit Service
  • Identify & recover overpayments
  • Prevent overpayments
• Inpatient (DRG Compliance Review)
• Outpatient (APC Compliance Review)
• Credit Balancing
• Coding compliance auditing services
• Professional compliance auditing services
  • Utilization review services
  • Provider-specific audits (benefit specific), comprehensive of a provider’s complete practice
  • Audits to assure correct process is followed for determining network discounts and allowances for out-of-state providers
  • Audits to determine that the correct network is utilized for out-of-state provides
  • Audits to determine timeliness of claims payment and other provider satisfaction issues
  • Review and respond (or provide recommendations) to appeals related to audit