HOSPITAL REVENUE CYCLE SOLUTIONS
HIPAA-CERTIFIED

Driven By

A Commitment to Excellence

And

Complete Client Satisfaction
1.
OUR PROMISE TO YOU: Audit ALL Managed Care Accounts for Contractual Compliance and Underpayment.
Welcome!

We’re thrilled that you found your way to our website!

We’d like to thank you, in advance, for considering Healthcare Retroactive Audits, Inc. (HRA), a company dedicated to the recovery of ‘Zero Balance’ Managed Care underpayments.

There’s no doubt that today’s healthcare environment is complex and rapidly changing. We recognize that complicated contracts and new coding regulations affect your organization’s financial well-being. In fact, many medical institutions lose millions of dollars annually because of an inability to identify and collect what is rightly due from Third Party payers.

HRA’s goal is to provide a professional and personalized approach for hospitals that need assistance with recovering what is due to them. Serving healthcare facilities for more than 15 years, we take great pride in the fact that we can significantly improve the bottom line of any client that chooses to use our services. Given our impressive track record, we’re eager to help your organization strengthen its financial position by boosting revenues, income and cash reserves.

We encourage you to explore the content of our website. Then, give us a call to discuss how we can best serve your institution’s wants and needs.

2.
OUR PROMISE TO YOU: Identify and Recover Underpaid Accounts by Working Directly With Each Contracted Payer.
Our Services

Industry-wide, underpayments range from 1% to 3% of Total ‘Net” Managed Care Revenue. Based on our experience, HRA has observed an average of approximately 2.4% across our entire client base. In light of this reality, HRA has consistently generated recovery rates of 90% for ‘Zero Balance’ accounts dating back 12 to 24 months.

We manually audit ALL accounts to ensure that the terms and conditions established in each negotiated managed care contract is honored. Given our approach, it should be clear that there’s no underpayment too small to pursue. And, given the sensitivity of patient data entrusted to us, our staff and systems are HIPAA-Certified, ensuring patient privacy and hospital confidentiality. Consistent with this assertion, regulatory compliance is given the highest priority throughout the entire audit process. As such, we adhere to all federal regulations and guidelines.

With today’s ultra-thin operating margins, no hospital or medical center can afford to disregard balances that quickly add up to millions of dollars of lost revenues. As we begin to see results from our audit activities, HRA gets paid only after a recovery is fully processed, paid and recorded in your system. While our efforts are labor intensive, our fees are 100% Contingency based. Combined with a low cost structure, we can offer extremely competitive rates, making HRA a very attractive business partner. This should eliminate any concern you may have about ‘Up-Front’ fees that were unbudgeted or a potential hit to cash flow.

Go ahead! Ask us for an estimate. It will be based on your facility’s size and annual managed care revenue.

3.
OUR PROMISE TO YOU: Make Recommendations for Future Contract Negotiations.
Our Auditing Process

There’s no mystery to the way we work at HRA. Our auditors review ALL aspects of each Managed Care contract (HMO, PPO, Managed Medicare/ Medicaid and any other contracts).

With your input and approval, we carefully plan all aspects of the audit. Being a ‘Turn Key’ operation, our superior audit experience and expertise allows HRA to identify likely areas of dispute or confusion that affect both Acute and Ambulatory Care Centers as well as Cancer Centers. As a vital part of this process, we carefully examine Stop-Loss provisions, Implants, Carve-Outs and Specialty Services (OB/GYN, Neonates, Critical Care, special drug/treatment protocols and more).

Our proprietary software facilitates the collection of Underpayments in a timely manner by tracking each account’s status. It also prompts our staff to routinely follow-up on every resubmission, denial and appeal within a highly accelerated timeframe. Given our approach, we’re confident that HRA can generate tangible results within three months of receiving our initial download of 2-years’ retroactive account data.

And, as an added benefit, we also provide an in-depth analysis of historical claims for your review.

  • UNDERPAYMENTS
    BY CONTRACT

    During our payment review and audit, we comprehensively study ALL ‘Zero Balance’ Managed Care accounts. We specifically look for coding validations and coding errors. These two items can represent a high source of revenue leakage, leading to incorrect documentation and reimbursement. As an integral part of our accretive consulting services, HRA is committed to finding ways to prevent future revenue leakage.

  • UNDERPAYMENTS
    BY ERROR

    Our proprietary software is capable of generating ‘Ad Hoc’ reporting tailored to your hospital’s needs. This can be extremely useful to hospital Operations as well as a valuable tool for future contractual negotiations. For example, we can report Underpayments by Error, including categories such as: Stop-Loss, Silent PPOs, Missed Filing Deadlines, CPT Coding and Outlier Rates. You’ll be able to easily identify the contracts that have the highest underpayments and recoveries and, through our auditing process, you’ll discover the most common errors made by each Third Party payer and more.

  • UNDERPAYMENTS BY
    CONTRACT & ERROR

    We have the flexibility to filter customer underpayment data in various ways. Analyzing Underpayments by Contract and Error allows customers to pinpoint the most critical areas of concern across all operational and functional locations within your facility.




4.
OUR PROMISE TO YOU: Identify and Recommend Areas for Operational Improvement.
The HRA Difference

Why audit manually? Why choose HRA?

Automated audits are geared toward speeding the process; to target and collect only high dollar underpayments. This approach overlooks a substantial number of underpayments that can be extremely difficult to detect. In today’s complex environment, you deserve more...

Well, we agree and we deliver more! We dig into the particulars. Yet, we insist that our activities will be virtually invisible; ensuring a minimal impact on your staff and daily operations. In addition to pursuing ALL underpayments, our audit provides clients with both detailed documentation and concise explanations. This feedback gives you all the tools necessary to address administrative or personnel issues, develop alternative recovery strategies and drive future Third Party Payer negotiations.

5.
OUR PROMISE TO YOU: Maintain Privacy and Confidentiality.
Contact Us

We welcome the opportunity to determine how we can help your company.

Please feel free to contact us through our website or simply give us a call today.

We look forward to hearing from you!

CALL: 1-888-756-9090
ADDRESS: P.O. BOX 228295, DORAL, FL 33172
EMAIL: info@healthcareaudits.net