AMPS audits reveal billing errors which have averaged 8% in additional savings over the past 5 years. Without AMPS, these billing errors would have been paid by the health plan with employers' money.
AMPS reports benchmark a hospital's gross billed charges and the PPO's net payable amounts (after discounting) against what Medicare would have paid. Even after PPO discounting, payment levels on hospital claims average 250%. That is 2.5x what Medicare will pay.
AMPS corrects errors, mistakes and overcharges on hospital bills prior to the application of a PPO discount. The large healthcare payers do not provide this service -- preferring to save themselves money by avoiding the cost of diligence.
With AMPS’ cost management solution, Medical Bill Review (MBR), all bills greater than $20,000 are audited for accuracy and reasonableness of charges. AMPS uses proprietary software that encompasses the aggregate knowledge accumulated over the past 15 years on 450,000+ audits and a line-by-line review performed by a physician review panel. The bills are corrected prior to payment and the payment levels are benchmarked relative to what Medicare would pay for the same service.
Regardless if a claim is in-network or out-of-network, hospitals charge the same way.
AMPS MBR service provides the opportunity to scour the claim to make sure everything being billed is correct and reasonable before payment.
The goal is to be 100% accurate on every claim. Physician reviews provide an extra layer of knowledge because they are in hospitals, operating rooms, and physician offices daily, they understand exactly what services are being rendered and why.