fast, accurate checks and balances
More than 90 percent of hospital bills contain errors – with two-thirds in the hospital’s favor. SHPS cost management solutions can help your organization correct this imbalance, ensuring that you only pay for accurate, validly coded services for your population. Our integrated cost management program combines clinical expertise and sophisticated analytical technology to identify and reclaim excessive healthcare expenditures. And our experience and national reach allows us to quickly place eyes-and-ears on the ground at any provider facility to provide high quality auditing services for our partners.

serving cost-conscious consumers
Healthcare consumers are increasingly conscious of costs. SHPS cost management solutions eliminates erroneous healthcare expenditures for our partners, and those savings can filter down to their members. Annual cost reductions allow our partners to provide a variety of health plans at reasonable rates. It also leads to premium maintenance – or even premium reduction. And by spotting these errors and lowering hospital bills, the co-insurance due on the claim often goes down as well. Providing such savings and serving as a watchdog for accurate costs will help your organization satisfy the demands of customers pursuing consumer-driven healthcare strategies.

targeted, consistent audits for the greatest savings
SHPS cost management solutions leverages more than 30 years of medical auditing experience to save our partners tens of millions of dollars annually. We offer a variety of options for any reimbursement methodology to meet your specific financial, service and administrative objectives. Unlike our competitors, we can place a directly-employed registered nurse auditor on-site – at no additional cost to you. These experienced auditors have access to SHPS’ historical audit results, allowing us to identify and focus on audits with the highest probability of savings for your organization. And our track record in securing hospital cooperation and recovering overpayments is unparalleled – with a 99 percent success rate in obtaining signed audit results agreements and 95 percent overpayment recovery within 60 days of audit completion.

SHPS cost management solutions offer its partners:

• speed-to-market. Partnering with SHPS allows your organization to quickly launch a best-in-class cost management solution for your organization and its members – without the extensive investment in time, training and resources required to build one from scratch.
  
  
• comprehensive service – from audit to recovery. Our full-service solution includes hospital bill audits, diagnosis related groupings (DRG) coding audits, overpayment recovery and clinical fee negotiation. So you can ensure that your customers only pay for accurate, cost-effective medical services.
  
  
• flexibility to meet unique needs. SHPS works with our partners in designing a cost management program that addresses your needs and business objectives. We are uniquely capable of supporting electronic claims data feeds, including FTP, tape, CD or e-mail. Hardcopy format (UB92) via mail or fax is also an option.
  
  
• specially-trained registered nurse auditors. SHPS’ auditors must be registered nurses trained in auditing procedures and practices. This training is provided by an in-house program that draws on SHPS’ 30 years of collective experience in performing audits. So your organization gains access to our flexible, professional workforce of more than 300 healthcare professionals, including more than 200 registered nurses and certified medical coders.
  
  
• targeted audits. SHPS nurse auditors can access audit results data from more than 6,000 medical providers to compare current charges to historic claim composition. That access, combined with their clinical experience and judgment, allows them to target audits with the greatest potential cost savings.
  
  
• nationwide service – no extra charge. We have six regional service centers and the ability to place our directly-employed nurse auditors on-site in any medical facility across the country – at no additional cost to you.
  
  
• documented results. SHPS cost management services saves our partners tens of millions of dollars annually. Our 99 percent success rate in obtaining signed audit results agreements and 95 percent overpayment recovery within 60 days speaks to our unrivaled expertise, accuracy and service.