Audit & Investigation
Fraud and Abuse
On an as needed basis, PMA is contracted by clients to provide objective 3rd party evaluation surrounding allegations and/or identifying fraud and abuse both internally or externally to their organization.
PMA also provides expert advice to client legal counsel in support of findings resulting from the evaluation of provided data.
Claims Audits
PMA Partners and Associates have the experience, capability, and resources to provide thorough, unbiased claims audits for Government agencies, Public Health Plans, Private Health Plans, Employer Self Insured Plans as well as Provider and Hospital Groups.
PMA analyzes claims payments based on benefit plans (covered services), contracted or published rates, and other defined payment rules (COB, etc...) to identify benefit discrepancies and payment errors . These engagements could be triggered internally to confirm or deny a suspected processing problem, investigate external allegations of wrong doing, or to simply to establish a measure of claims payment accuracy.
Billing Audits
PMA billing audits are designed to expose not only where in your billing process you may have problems, but also where you may be leaving money on the table. Billing audits performed by PMA evaluate the billing process from the provisioning of the service in the clinical setting through generation of the bill to the payor.
PMA associates conduct data collection on-site for evaluation. Clients are then provided with a preliminary and final report with recommendations and metrics for your billing processes you can use for comparison to the past or against the future.
On an as needed basis, PMA is contracted by clients to provide objective 3rd party evaluation surrounding allegations and/or identifying fraud and abuse both internally or externally to their organization.
PMA also provides expert advice to client legal counsel in support of findings resulting from the evaluation of provided data.
Claims Audits
PMA Partners and Associates have the experience, capability, and resources to provide thorough, unbiased claims audits for Government agencies, Public Health Plans, Private Health Plans, Employer Self Insured Plans as well as Provider and Hospital Groups.
PMA analyzes claims payments based on benefit plans (covered services), contracted or published rates, and other defined payment rules (COB, etc...) to identify benefit discrepancies and payment errors . These engagements could be triggered internally to confirm or deny a suspected processing problem, investigate external allegations of wrong doing, or to simply to establish a measure of claims payment accuracy.
Billing Audits
PMA billing audits are designed to expose not only where in your billing process you may have problems, but also where you may be leaving money on the table. Billing audits performed by PMA evaluate the billing process from the provisioning of the service in the clinical setting through generation of the bill to the payor.
PMA associates conduct data collection on-
