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2301 River Road
Suite 302
Louisville, KY 40206
(502)426-9680
888-426-9680
(502)426-8272 fax
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Hospitals and Healthplans
PHD offers a variety of services related to specific customer's
needs. Examples are:
UTILIZATION MANAGEMENT SERVICES
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- Audit and Analysis of UM Function and Effectiveness
- Hospital On-Site Full Time or Locum Tenens
UM Staff
- Hospitalist Program
- Emergency Services UM review
- Professional Service UM review
- Diagnostics UM review
PHYSICIAN NETWORKS top
- Since we have contracts with multiple payers in two Kentucky markets,
we can analyze whether the professional fee schedule of a network provider
is competitive and if there are any aberrant patterns (over coding,
etc.).
- PHD has CPCs on staff who conduct coding audits on many physician
practices.
- We also have data on payment methodologies and relative rates for
hospitals and other providers.
- Taking prior years CPT code experience, we can collate multiple networks’
provider fee schedules to an employer’s service code frequency
to identify opportunities for additional pricing value.
- We can also assist in contracting with and re-pricing claims for providers
not in a network.
PHYSICIAN
EDUCATION top
- Tailored Physician Education Programs
- Physician Incentive Arrangement Development
- Medical Director consulting.
CLAIMS ANALYSIS top
Pre-adjudication or Retrospective Healthcare/Payer Claims Audits
Claims are reviewed for:
- Eligibility
- Duplicate Payment
- Payment Consistency
- Carve-outs and Capitation
- Unauthorized Services
- Non-covered Benefits
- Primary or supplemental to other vendor (COB).
BENEFITS
During our initial claims review, we discovered that one large and respected
insurer had an error rate on pre-adjudication of 7%. After three years,
we still identified an overpayment error rate of 2.2%.
For the insurer's 40,000+ lives, we estimated savings due to claim review
of over $5 million. We have also helped that same payer improve its claims
payment operations.
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