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Commercial and Managed Care Outlier Audit

With the continued complexity of many payer contracts, combined with inadvertent charging errors, you may be losing the potential for greater reimbursement for the valuable services you are providing. Praxis Healthcare Solutions will partner with you to perform an audit of accounts that did not meet your outlier threshold, but came within 2 to 3% of your outlier clause. Our clinical team will provide a charge audit of those accounts in order to identify any that may have been undercharged and upon recalculation of a correct bill, can further pinpoint those eligible for resubmission with the correct claim which would now qualify for additional payment. Praxis Healthcare Solutions will handle the rebilling and follow up on the accounts until successful resolution.

Key Benefits

  • Potential found revenue

  • Avoidance of future loss

  • Staff Education

  • Compliments Compliance Program

  • Identification of process breakdowns

  • Minimal time commitment of hospital staff resources