Ingenix Software Simplifies Medical Claims Audit and Appeal Processes for Hospitals and Physicians

Audit Management provides single application for managing multitude of audits conducted by government and commercial health plans

EDEN PRAIRIE, Minn. (June 28, 2010) –

Ingenix’s CareMedic unit has enhanced its Audit Management software, giving hospitals and physicians a single system for managing compliance with multiple medical claims audits conducted by government and commercial health care plans.

Medical claims audits help ensure prompt, accurate payments for health care services. However, managing reviews and potential appeals can impose significant administrative costs to health care providers. Audit Management provides dashboards and administrative tools that help hospitals and physicians efficiently manage steps in the audit process from the time they are notified to completion of the claims review. Specifically, the software details information requirements and deadlines, organizes tasks into helpful work lists and provides progress updates and performance reports throughout the audit and any subsequent appeal.

Audit Management also helps hospitals and physicians predict the potential financial impact of claims audits. Further, the application enables users to examine their current and historical claims data to identify claims that may trigger an audit, locate and resolve the source of errors and take action to reduce the chance of future reviews.

“Ingenix’s Audit Management software enables Bethesda Memorial to manage claims review processes more efficiently,” said Bethesda Memorial Hospital Director of Patient Financial Services Pamela Abbott. “The application details the document requirements and brings project management and progress reporting tools together in one place. This ensures we respond to claims review requests with timely, complete and accurate information.”

“Ingenix is helping hospitals and physicians simplify administration and reduce costs when managing medical claims audits,” said Ron Jones, senior vice president of hospital solutions at Ingenix. “Audit Management is a single system for tracking and managing workflow–from audit initiation through appeals–for any claims review initiative.”

In addition to Audit Management software, hospitals and physicians can engage Ingenix Consulting for audit support programs that help them identify and address areas of potential audit exposure. Ingenix Consulting offers extensive health system operational expertise and can conduct mock audits and shadow audits that help hospitals and physicians improve processes and minimize risk.

Claims reviews prevent improper payments
The U.S. Department of Health and Human Services estimates that improper payments through Medicare and Medicaid cost federal and state governments approximately $50 billion in fiscal year 2008. The Centers for Medicare & Medicaid Services (CMS) implemented its Medicare Recovery Audit Contractor (RAC) initiative in 2009 to recover improper payments and deter waste fraud and abuse. Audit Management provides comprehensive support for the RAC audit process and other CMS medical claims reviews, including the Medicare Administrative Contractor, Medicare Comprehensive Error Rate Testing and Medicaid Integrity Contractor initiatives.

For more information about Audit Management from CareMedic, call 800-508-8494 or visit http://www.caremedic.com/Audit_Management.aspx. For more information about audit support from Ingenix Consulting, call 866-223-6738 or send email to engage@ingenixconsulting.com.

About Ingenix
Ingenix, a UnitedHealth Group (NYSE: UNH) company, is a leading provider of health information, technology and consulting services. Organizations, institutions, businesses and government agencies that comprise the health care system depend on Ingenix solutions and insights to improve their performance. Visit www.ingenix.com for more information.

Source: Ingenix