Accent has developed a comprehensive approach to the identification of overpayments. Accent’s proprietary Data Mining application works to both electronically and manually identify potential overpayments via programmable and customizable electronic edits.

Accent identifies the full range of improperly paid claims including, but not limited to:

• Overpayments made as a result of missed COB
• Duplicate payments
• Eligibility
• Contractual overpayments related to per diem rate and fee schedules
• Cardiac claims, case rate
• DRG and procedure (i.e. mom and baby) claims
• Outpatient surgical groupers (CPT/procedures tied to a schedule reimbursement amount)
• Maximums (procedures that are specifically tied to a maximum allowance)
• ER visits, incorrect provider discounts
• Retroactive contract loads
• Terminated provider contracts

In addition to automated overpayment identification, Accent's process employs a search engine application. The combination of human analysis with the power of a search engine that queries thousands of claims in a matter of seconds is able to discover overpayments that edits alone can't find. These focused searches concentrate on identifying the types of overpayments that result in the highest return.

After identifying a potential overpayment, Accent's data mining application automatically presents the claim to a team of validators. These validators use view-only system access to manually calculate and verify that the claim is truly overpaid. Provided with view-only system access, Accent validates 100% of potential overpayments, a claim few overpayment identification vendors can make. We know that no matter how “tight” an edit may be, claim situations will exist that look overpaid according to the edit but the claim history tells another story.

After validation, the claim history is reviewed for additional instances of overpayment, or as we refer to it – an “upvalue” opportunity. Finally, all identified, verified, and “upvalued”, accounts are sent to Accent's experienced recovery specialists for recovery activity, or can be returned to our client to perform their own internal recovery efforts.

Additionally our clients benefit from an entire data mining research and development department. This department is dedicated to identifying overpayment leakage, contract and claims analysis, and the monitoring of client’s paid claims activities, standard operating procedures and contractual provisions for new overpayment opportunities. Lastly, this department is responsible for regular industry research in order to stay current on claim billing practices and Medicare guidelines that may result in new overpayment opportunities. For more information on these benefits, click here.