Outpatient HIQUP report

Our HIQUP (Hospital Improvement in QUality and Performance) Report provides assurance to you and your facility. Currently utilizing over 200 custom edits, we closely examine your outpatient Medicare data to find what pre-billing audits and other edit tools miss; providing actionable information to maximize your future payments and minimize potential risk.

We review each and every line item of a facility’s 835 Medicare remittances. Through a customized data mining process, we identify specific claims, allowing us to target our review, identifying areas of concern that affect your bottom line. The HIQUP report, which can be run on a quarterly or monthly basis, contains both a global view of your total reimbursement and laser focus on particular issues of risk and compliance.

Please click the link below to download our HIQUP Report How-To.

The HIQUP report is designed to help you better prepare your facility for the scrutiny of Medicare and their associated entities by identifying:

  • Areas of non-compliance, including the risk of overpayment
  • Opportunities for reimbursement
  • Improve coding and billing processes by providing benchmarking information for key performance indicators

Some of the specific areas that are audited include:

  • Medical necessity, claim denials, and line item rejections
  • HCPCS/CPT-4 code assignment
  • HCPCS/CPT-4 codes and revenue code linkage
  • Appropriateness of modifier application
  • Units of service
  • Value and condition codes
  • "Date spans"
  • Non-covered codes
  • Billing manipulations
  • Edit validity
  • Physician legibility
  • Appropriateness of bill type

Please click the link below to download our Resources Guide for HIQUP's Medicare Policies Report.

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