Oftentimes hospitals charge patients for services, medications, and supplies before they are actually received or even bill duplicate charges. Frequently there are data entry errors due to complicated or inefficient billing systems in hospitals. Other times there is change in the doctor's orders or an early discharge from the hospital that can effect the accuracy of the bill. These are just a few of the reasons why hospital bill charges may be deemed inappropriate.

HDM's Hospital Bill Audit Program is an effective method for self-insured employers to save money and monitor large dollar claims. With our auditing service, our auditors review line items and document inappropriate charges on a retrospective basis to determine appropriateness of charges and identify overpayments. In addition to our veteran audit team, we utilize a nationwide network of experienced nurse auditors who go onsite to the hospitals to perform chart audits. Records are reviewed and validated and charges are corrected based on the actual services when necessary. Additionally, cases are checked for contractual compliance, corrected reimbursement amounts are identified with all findings documented and submitted in a final report.

The following are the types of hospital bill audits HDM provides:

Bill Review and Chart Audits
HDM auditors achieve the most thorough results by scrutinizing, line-by-line, all items in the itemized bill to check for billing inconsistencies and overcharges. If necessary, we compare the medical record which includes doctor's orders, nurse's notes and various department reports to the itemized bill to ensure that items billed were documented in the medical record.

DRG Validation
Diagnosis Related Groups (DRG) form the basis for most hospital charges. HDM analyzes DRG claims electronically, providing an efficient and effective method to reduce claims exposure. HDM's experienced audit team will screen 100% of DRG claims and then audit designated claims and medical records to determine appropriateness of the DRG.

To learn more about our cost containment solutions for self-insured employers, contact HDM today at 800.859.5119 or request information with our online form. You may also send an email to: info@HDMinc.com.