Pre-payment Analytics

Utilization Management

FraudCapture

Inpatient Readmission Review

Readmission Prevention Solution

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.

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.

Episode of Care FAQ

Here are the most frequently asked questions about HMS' Episode of Cares solution.

Genetic Testing FAQ

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

Comprehensive Solutions for Medicare Advantage Plans

HMS' suite of Medicare Advantage services are designed to help MA plans overcome industry forces that create pressure to optimize revenue, reduce costs, minimize risks, and improve outcomes.

Pre-pay Clinical Claim Review FAQ

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

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.

ER Billing Compliance

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

ER Billing Compliance FAQ

Pre-pay Clinical Claim Review