Our Solutions: Payment Integrity

  • How Pre-Payment Integrity Can Incentivize Evidence-Based Care

    How Pre-Payment Integrity Can Incentivize Evidence-Based Care

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  • Episode of Care FAQ

    Episode of Care FAQ

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  • Pre-payment Analytics

    Pre-payment Analytics

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  • Utilization Management

    Utilization Management

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  • FraudCapture

    FraudCapture

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  • Inpatient Readmission Review

    Inpatient Readmission Review

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  • Readmission Prevention Solution

    Readmission Prevention Solution

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  • Clinical Claim Review

    Clinical Claim Review

    HMS' Clinical Claim Reviews leverage a vast knowledge base from clinical experts, credentialed physicians, and healthcare data scientists to improve payment accuracy and minimize pay-and-chase.

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  • Episode of Care

    Episode of Care

    Episode of Care is a semi-automated payment accuracy solution from HMS that analyzes a patient's claims history related to an episode of care to identify discrepancies and recover overpayments.

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  • Genetic Testing FAQ

    Genetic Testing FAQ

    Here are the most frequently asked questions about HMS' Genetic Testing solution.

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  • Looking Ahead to 2022: Payment Integrity, Claims Accuracy, and Premium Protection Will Be More Important Than Ever for MA and Part D Plans

    Looking Ahead to 2022: Payment Integrity, Claims Accuracy, and Premium Protection Will Be More Important Than Ever for MA and Part D Plans

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  • Financial Sustainability and COVID-19: Strategies to Avoid Health Plan Budget Shortfalls

    Financial Sustainability and COVID-19: Strategies to Avoid Health Plan Budget Shortfalls

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  • Pre-pay Clinical Claim Review FAQ

    Pre-pay Clinical Claim Review FAQ

    Here are the most frequently asked questions about Pre-pay Clinical Claim Review.

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  • Readmissions Review

    Readmissions Review

    Inpatient hospital readmissions are costly for all payers. HMS can target readmission pairs in which the claims data indicates the second admission is for the same or similar condition.

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  • Genetic Testing Solution

    Genetic Testing Solution

    Incorrect payment of genetic test claims persists despite preauthorization programs. HMS offers a solution that generates significant savings by increasing payment accuracy for genetic testing.

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  • ER Billing Compliance

    ER Billing Compliance

    ER Billing Compliance is a payment accuracy solution from HMS that addresses inappropriate ER Level 5 billing.

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  • ER Billing Compliance FAQ

    ER Billing Compliance FAQ

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  • Pre-pay Clinical Claim Review

    Pre-pay Clinical Claim Review

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  • Generate Pre-Payment Claim Review Savings By Aligning Payer & Provider Incentives

    Generate Pre-Payment Claim Review Savings By Aligning Payer & Provider Incentives

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  • Are You Overpaying for Emergency Department Level 5 Services?

    Are You Overpaying for Emergency Department Level 5 Services?

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