Based on a coding compliance auditing model, the projected yearly savings can be as high as $6 million of verified over-payments for every 100,000 members in a DRG payment environment (inclusive of a blend of Medicare, Medicaid, and commercial lines of business, and geographic variations in DRG base rates.) What’s more, the first year of auditing can yield up to triple the typical savings due to CMS regulations that provide eligible plans a three (3) year look-back period for historical claims, barring contractual restrictions. This is “found money” to a plan’s bottom line and a scaled-up return for the start-up service period.
