Using tools developed by MAS to determine the accuracy and appropriateness of billing and payment procedures, MAS examines health plans’ contractual pricing agreements to ensure accurate reimbursement of each claim. Under this program, MAS discovers:

  • DRG, APC and ASC payment calculation errors
  • Case rate errors
  • Outlier calculation errors
  • DRG assignment errors
  • Outpatient unlikely edits
  • Outpatient status errors for claims affected by “inpatient only” procedure rules

Using the processes outlined above MAS has recovered significant revenue for its clients that would otherwise have been lost. As an added benefit, this process has also helped clients improve their oversight to prevent future overpayment errors.

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