Revenue Recovery
contractual payment problems
news and events
Fights Over Health Claims Spawn a New Arms Race
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Art. 21.21. Unfair Competition and Unfair Practices
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BAYLOR UNIVERSITY MEDICAL CENTER, ET AL., Plaintiffs, VS. EPOCH GROUP, L.C., Defendant
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BAYLOR UNIVERSITY MEDICAL CENTER, Plaintiff, VS. ARKANSAS BLUE CROSS BLUE SHIELD, Defendant
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Court Rullings Legislation
hospital managed care
insurance claims
Your hospital or health system has lost significant revenue (possibly millions) to:
  • Non-compliant managed care discounts – silent PPO’s, timely payment violations, wrongful application of HMO rates instead of lesser discounted PPO rates, etc,
  • Contractual underpayments – due to incorrectly loaded or outdated rates, short-payments, erroneously bundled charges, incorrect application of benefits, etc,
  • Wrongful denials of either: days, procedures or entire claims,
  • Unreasonable “usual and customary reductions” or “line item reductions”,
  • Various other forms of underpayments.
  • Since 1996, PPO Check has continued to excel as the industry leader in providing auditing and consulting services for our hospital and health system clients.

We have generated tens of millions of dollars for our clients (as much as $42 MILLION for one hospital client) from closed zero insurance balance accounts – many times after the same patient account data had been previously scrutinized by our clients’ internal processes and policies as well as by one or more other auditing firms.

members
Louisiana Hospital Association - Texas Hospital Association - Florida Hosptial Association - American Hospital Association - Nevada Hospital Association
hospital billing and coding procedures
Underpayments
houston cunsulting
audit houston
Louisiana Hospital Association Texas Hospital Association Florida Hospital Association American Hospital Association The Political Action Committee for the Texas Hospital Association Nevada Hospital Association