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Auditing Services Overview: Since 1995, Health Check has been an industry leading managed care and Silent PPO auditing firm. Our primary service is the auditing of your facility’s zero balance managed care accounts. These are accounts that your billing department has closed as paid in full. Our audits uncover cases where your managed care payors have not paid according to their contracted terms. Once underpayments are identified, we work on your behalf to collect all of the money due to you. All payments are sent directly to your facility, and we only invoice based on successful recoveries. There are no hidden fees — all expenses are covered by our contingency fee, even our travel.

Typical Project Stages:

• Data
• Contract Review
• The Audit
• Recoveries

Health Check places very high importance on information and infrastructure security. Our elite team of technical professionals includes regulatory compliance experts, certified information security professionals and HIPAA certified security specialists. We have significant experience with all of the popular patient accounting and billing systems, including: Siemens applications (Invision, MedSeries 4, OAS, OAS GOLD, etc.), Meditech, IDX (LastWord), IBM AS/400 applications, Misys, QuadraMed (Affinity), CPSI, IntraNexus (Allegra), and McKesson (STAR 2000 and HealthQuest).

Our Information Technology department works with your staff to produce the data files required for our audit. Our initial audits typically cover two-years, and our ongoing audits require new data on a monthly or quarterly basis. Health Check is equipped to receive data using a variety of HIPAA-compliant methods.

If your facility is unable to provide electronic copies of your managed care contracts, representatives from Health Check come to your facility to scan copies of all of your managed care contracts. We then conduct a thorough review of all the contracts, which includes the development of a complete rate matrix for all of your contracts. We share these matrices with our clients in both electronic and paper formats.

Our experienced Auditors then conduct a line-by-line analysis of payments received to determine whether the payors have reimbursed your facility pursuant to the terms of their contracts. We do not rely on the use of electronic payment calculators, coding scrubbers, or contract management systems, as most facilities already utlilize those systems. While our process involves higher staff knowledge and effort, our results speak for themselves. <to learn more about the benefits of our manual audit, click here>

Once underpayments are identified, our collections team works on behalf of your facility to collect all money due to you. Our professional Recovery Department makes routine phone calls, submits written appeals, and works with our nurse auditors to generate medical appeals. All payments recovered by our efforts are received directly by your facility. <to learn more about our results, click here>