The scrutiny of the health care industry in today’s society is daunting.  Across a multitude of medical professions, health plans and networks, the need for an independent assessment of a Company’s health claims billing, processing and payment systems is growing in importance.  And our practice is growing with it.

This is a natural fit given our specialization in the health care industry.  Our experience with physician groups, claims processing and management centers and other health care providers enables us to provide this value added service to fit your needs.  Those needs could be to meet the compliance requirements of certain regulatory authorities or to establish a self monitoring mechanism for your business.

Compliance driven engagements are more stringent.  Regulations will often times govern how to test the claims billing, processing, or payment systems and determine the reporting format to the proper governmental or regulatory agencies.  The experienced staff of Hansen, Hunter, and Company offers a unique advantage to meet these requirements.

Agreed upon procedures engagements for internal purposes offer more flexibility.  The client sets the scope of examination.  For example, such parameters may include determining the sample size, setting the threshold for error rates, or identifying the direction of focus for testing (e.g., types of claims or contracts).  Client discretion also determines the format of the report.

These engagements often include one or more of the following services:

• Analysis of various billings, processing, and payments systems (e.g., Medicare, private) to determine accuracy and efficiency.

• Independent verification of payments to providers based on contract provisions and prevailing fee schedules.

• Concise reporting according to regulatory or management standards.

• Recommendations for claims processing and management.

We tailor all engagements to be client specific with the goal of meeting your needs and expectations. Please contact Jeff Moore, or Jon Beckman at our office (800) 547-3159 for more information.