SYSTEMATIC PAYMENT AUDITING

摘要

A systematic audit of payment amounts for collections received for billed service is performed to identify payment discrepancies. Prices are assigned to service codes by government payers and private insurance companies with numerous variations. Each type of price model and variant is stored in a data repository. The price model may be categorized and applied per facility and per payer. Payment amounts are analyzed for price and billing code accuracy to determine whether the received payment accurately reflects the pricing model.