M-Audits Frequently Asked Questions (FAQ)
1. Who is M-Audits?
M-Audits is a Healthcare Services Auditing Company that works with employers to ensure that claims are properly billed. The M-Audits Medical Bill Review System combines the experience of highly skilled nurse reviewers and our state-of-the-art medical billing software to achieve lower claim costs on both hospital and physician bills.
2. My TPA is already auditing for me. How is the M-Audits review process different?
Typically, most TPA’s audit claims for their adjudication and payment processes only. A simple review of hospital claims and revenue codes is not a sufficient means of identifying billing errors and overcharges. In order to reduce payments for billing errors and overcharges, a more thorough review needs to be undertaken. The M-Audits process involves two distinct but important steps.
Step 1: Financial Review – Line-by-line comparisons of the supporting hospital claim itemization are the only valid way to adjust for incorrect billing practices and to supply corrected standard fees for ‘usual and customary’ areas of treatment, supplies, etc. M-Audits performs the audit of hospital or physician bills to determine if there were inaccurate charges.
Step 2: Clinical Review – M-Audits uses trained medical staff to provide a more thorough review of claims reaching a certain dollar threshold.
3. How does M-Audits make money reviewing claims and what is the cost to me?
Because M-Audits uncovers so many hospital and provider billing errors, we are able to work on a contingency basis… so you pay nothing unless we successfully reduce your claims expenses and save you money.
4. What are the typical savings the employer can expect?
The average total savings for the claims reviewed is 10%. Typically, we see an 8 – 12% savings on hospital bills and a 20 – 30 % savings on provider bills.
5. Will my employee be balance billed?
Not necessarily, M-Audits is so successful uncovering billing errors that our appeal rate is very low; however, we cannot control what the hospital does. If your employee is balance billed, we will work with them through our Patient Advocacy Program.
6. Is there a start-up cost?
No, there is no start-up cost. M-Audits needs a copy of the UB-92, Itemization, and HCFA to get started.
7. Which claims should be sent to M-Audits and can I monitor them during the process?
The client determines which claims should be reviewed by M-Audits. Generally, claims that reach a certain dollar threshold, are out-of-network, or that have certain clinical triggers (disease focused) are audited. M-Audits will give your office the ability to track the claims during the audit process via a secure internet connection.
8. Will our company receive its PPO discounts if M-Audits audits claims for its self funded plan ?
Absolutely, however, many providers would lead you to believe that you cannot audit and take the PPO discount. M-Audits has legal precedence that verifies the right, and actually the fiduciary responsibility, of a self-funded plan to audit claims in order to assess the ‘appropriate billed charges’ after which the PPO discount is then applied.
9. Does M-Audits require an agreement to utilize their services?
Yes. M-Audits requires an agreement. This document outlines each party’s responsibilities.
10. What do I need to do to get started?
Once the agreement is signed, just fax us the UB-92, Itemization and Medical Records or HCFA to M-Audit, and we will take care of the rest.
For more information on the
M-Audits Medical Bill Review program call 888.404.9500 or email us at sales@m-audits.com |
