Since inception, Equian has been perfecting our technology and building relationships with over 3,500 hospitals nationwide to perfect a strategy that yields optimal recoveries with not just minimized abrasion but actually enhanced relationships.
Total Claim Score Engine (TCS)
With our proprietary Total Claim Score Engine, we score every claim, small and large and identify over 7% overpayments vs. industry standard of 3%.
We also know that cutting-edge technology is not enough. That’s why we use a blended approach that allows us to be smarter and more efficient than the competition. Expert human review of the analytic output is still necessary to achieve smart and efficient claim selection. Through this process, we identify claims most likely to have been overpaid and that will result in a financial recovery, so we make the most efficient use of auditing time which minimizes abrasion.
Every DRG auditor has a minimum of 15 years of audit experience and AHIMA and/or AAPC and CCS certification. Our carve-out auditors must be nurses, typically with 10+ years of operating room experience, and deep knowledge of high-cost drugs and implantable devices.
Onsite audits enable access to full medical records, two-way dialogue, and the ability to develop personal relationships with providers. Onsite audits also allow for larger audits that deliver greater savings.
Equian has relationships with over 3,000 hospital systems in 50 states. These relationships and the deep expertise and credibility of our certified audit staff lead to expedited sign-offs and collections.
Lower Appeal Rates
Upon completion of all audits, we obtain a signature from the provider acknowledging the overbilling. This expedites the collection of the overpaid dollars and limits further disputes.