Renal Dialysis Billing Audits

Renal dialysis providers consistently receive overpayments made by Blue Cross plans, commercial insurance carriers and government-sponsored health plans.

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Many factors contribute to overpayments, including pressures on both providers and payers to expedite claims processing, incomplete information and confusion surrounding Coordination of Benefits guidelines and overly complicated Medicare Secondary Payer regulations that pertain to dialysis services and dialysis billing.

Overall payments made for renal dialysis treatments have increased 190% since 1990, due to both the effectiveness of treatment and the availability of dialysis services. This trend and the growing cost to payers is expected to continue to increase as the population ages. Given that a full month of renal dialysis services may cost a payer several thousand dollars, there is a significant opportunity for overpayment recovery in this growing, yet often overlooked, category of providers.

By engaging Conduent to perform Renal Dialysis Billing Audits, payers receive improved profitability and cash flows through the recovery of dollars that were previously undetected. Our professional staff conducts the comprehensive dialysis billing audit with little or no disruption to providers at no financial risk to our payer clients.

Our professional services go far beyond a surface-level review or data mining approach. Conduent’s Renal Dialysis Billing Audit Program includes a review of 100% of the primary payments made to each dialysis facility. We review both provider- and payer-supplied documentation to identify all potential overpayments made to providers on behalf of our payer clients. Prior to recovery, we present these overpayments to the provider for review and approval. Conduent handles all aspects of the project from the initial scheduling of the review with the provider to recovery of the funds via check or via approval to recover the claims. Our proven approach ensures that all credit balances and overpayments are recovered by the appropriate party with minimal effort on the part of the provider.