brad cope hms general commercial brochure

Our powers include:

Tradeshow Brochure - Commercial • 4/4 with Soft Touch Aqueous Coating on the cover • 16"W x 5.25"H flat (8"W x 5.25"H folded) • Built @ 100% Proofed @ 100% • MechanicalDesigned by Tad Dobbs • April 3, 2015

The Origin StoryWe’re the Integrity League: a fraud-fighting, risk-crushing, truth-seeking team of superheroes who power the healthcare system with integrity. Since we joined forces in 1974, we’ve fought for medical claims to be paid correctly and benefits to be coordinated properly. Commercial insurers trust us to provide the most comprehensive solution set in the business, in just the way they want it. And we deliver. Every year we recover billions for our clients and save them billions more through the prevention of erroneous payments.

Like what you see? Summon us at hms.com to learn more.

• Complex Clinical Reviews• Commercial Coordination

of Benefits• Credit Balance Audits

• Dependent Eligibility Audits• Fraud, Waste, and Abuse

Detection and Prevention• Medicare Secondary Payer

Revenue Protection

• Overpayment Identification and Recovery

• Short-Stay Reviews• Subrogation Solutions

Complex Clinical ReviewsA myriad of evil forces lie behind incorrectly billed medical and pharmacy claims. Errors can hide in reimbursement methodology; inpatient, outpatient, and durable medical equipment; covered vs. non-covered services; medical necessity; readmissions; and level of care.


BenefitsYou name it. We’ve got it covered. Our algorithms and

statistical analysis spot the medical records most likely to cause chaos. Then our team of more than 300 physician reviewers

gets the job done.

The Villain: Payment Mayhem

Our Superpower: Fist of Doom

Commercial Coordination of Benefits

Our commercial coordination of benefits solution tracks down other party coverage with ease. What does that mean for you? An end to administrative headaches and an estimated savings of up to 25 cents per policyholder per month.

The Villains: Administrative Burden & Provider Abrasion

Our Superpower: Proactive Wisdom


Credit Balance AuditsWhile inferior leagues rely too heavily on one single power—like subrogation or fraud—HMS gets to the root cause of overpayments. We share our findings with providers and clients, boosting our overpayment recoveries up to 50% higher than others.

The Villain: The Root Cause

Our Superpower: The Eye of Detection

Fraud, Waste, and Abuse Detection and PreventionFor more than 25 years, the HMS Integrity League has fought fraud, waste, and abuse in the healthcare industry—coming out on top every time.

BenefitsWe use several methods to bring villains to justice:

prepay clinical reviews, forensic coding and predictive analytics, and investigations support. We audit the broadest array of claim types, and our new

prepay clinical reviews help you ensure medical records support the claims before you pay. That’s what we call superpowerful!

The Villains: Fraud, Waste, and Abuse

Our Superpower: The Ray of Justice


Dependent Eligibility AuditsAn ineligible dependent can sneak onto your health plan like a thief in the night and endanger your bottom line. HMS weeds out the 4% to 8% of ineligible dependents, generating a 400% to 1,000% return on investment.

The Villain: Unnecessary Costs

Our Superpower: Amazing ROI Lift


Medicare Secondary Payer Revenue ProtectionCorrecting inaccurate other coverage information from the Centers for Medicare and Medicaid Services can be daunting for your Medicare Advantage plan, resulting in significant revenue loss. With our solution, a plan with just 50,000 members could add $3 million to $4 million to the bottom line in just a few months.

The Villain: Faulty Intel

Our Superpower: Mega Info

OUR SYSTEM WILL SEND YOU ALL PACKING.

Overpayment Identification and RecoveryImproperly billed or paid claims can add up to some serious loot. But HMS has masterminded data analysis queries and algorithms to compare claims history against specific billing, coding, coordination of benefits, utilization, and reimbursement rules.

BenefitsThe Integrity League’s comprehensive claims analysis system has the power to identify and recover overpayments for all claim types across multiple lines of business. We’re all-knowing: Our overpayment identification and recovery service is prospective and retrospective—and customizable to fit your needs.

The Villains: The Swindlers

Our Superpower: The Sweeper


Subrogation SolutionsDon’t be lured into wrongly paying for all types of claims—from casualty to tort to workers’ comp. Meet Maestro, HMS’s state-of-the-art case management system. Our custom-built, web-based system empowers you, helping you avoid the pitfalls of recovery by placing industry best practices, secure Internet access, and real-time updates at your fingertips.

The Villain: Subrogation Complexity

Our Superpower: Maestro Dropkick

BenefitsFinally you can manage the huge amount of information— name ‘em: other insurers, providers, county offices, attorneys, and state workers’ compensation agencies—needed to sail through subrogation determinations. Fire up Maestro and see the difference our system makes.


Short-Stay ReviewsShould those one- to three-day inpatient admissions have been less-costly outpatient treatments? HMS Short-Stay Reviews find the answer, using a powerful one-two punch of statistical analysis and medical record reviews. Pursue recoveries on your own, or let our team handle the job.

The Villain: Automatic

Inpatient

Our Superpower: Analysis

and Review Combination

brad cope hms general commercial brochure

Documents

medical claims

medical records

abuse detection

durable medical equipment

reviews subrogation

commercial insurers

hms integrity league

eye of detection