Q. Is TrueFACS different than a TPA?

A. Yes. TPA's process hospital claims. TrueFACS audits every charge on the itemized bill for accuracy.

Q. What about balance billing?

A. No problem! We are contracted with ERISA attorneys to defend our findings (included as part of our service) against any balance billing attempts by a hospital or facility at which time we get sign off.

Q. Who should use TrueFACS and why?

A. Anyone responsible for processing or paying hospital bills and/or outpatient surgical bills OR anyone who authorizes the use of funds to pay those bills. Everyone in the payer chain has a fiduciary responsibility under ERISA to assure those bills do not contain erroneous charges so as to provide the most cost effective healthcare to the employees and/or members.

Q. Are you insurance?

A. No. We are specialists that scrutinize every charge on the itemized bill to assure that you are paying an accurate hospital and/or outpatient surgical bill…then apply the PPO discount.

Q. What is the value of a PPO discount?

A. Less than nothing if the item/service wasn't billable to begin with or even if it was billable but the price was inflated…because it creates an illusion of savings.

Q. How long is the term of your contract?

A. Business requires contracts so as to define responsibilities and limitations and of course to protect all parties. We have faith that our service is of real value; however our belief is that if something is not "good" for all involved there should be no restrictions to ending the agreement. Therefore our agreements can be cancelled with a 30 day written notice. Of course you can just stop sending us claims.

Q. What's the claim $ threshold?

A. Common sense dictates that our success rate will determine the number of claims you want us to audit. As a rule of thumb every hospital bill and outpatient surgical bill includes a large percentage of errors so just send us the claims you want to pay accurately.

Q. How long does your audit take?

A. We operate well within each State's statutes that mandate the timeliness of claims payment. Our audit takes between five (5) and ten (10) business days. Savings are realized virtually immediately. We prefer to audit pre-payment, post adjudication, however in certain cases because of current plan language we may be required to audit post payment, however the answer is still the same.

Q. Can you audit post payment?

A. We audit both pre-payment and post payment. The key is to irrefutably determine that in fact your employee and/or member hospital and outpatient surgical bills do not contain erroneous charges. Whether pre-payment or post payment, our audit provides a defensible position for performance of fiduciary responsibility under ERISA.

Q. What about a DRG or Case Rate claim?

A. Yes. When a payer uses DRGs or Case Rates you will almost always have an Outlier Clause. When the outlier is pierced the claim reverts from the DRG payment (a flat rate) to a discount off of billed charges. Thus, when DRGs or case rates are in effect we would only want to review the claims that pierce the outlier. In some cases we will get the claim below the outlier reinstituting the DRG or per diem rate. In all cases we will reduce the size of the bill.

Q. What's your fee on pre-payment audits?

A. We expect that you will pursue savings that we have identified and then work on a percentage of savings that you "actually" achieve. Savings" shall mean the difference between the lower of either (a) the original total charges billed by a provider or (b) the amount of such charges that would normally be paid by under your existing contract with the provider, less the corrected, adjusted amount calculated by TrueFACS. For example if we saved $20,000 and you have a 20% PPO arrangement our contingency would be based on having saved you "actually" $16,000.

Q. How do we get started?

A. After we execute an agreement, we provide a HIPAA compliant secure web portal to upload the claim data. Your claims manager loads the data (similar to sending an e-mail) and completes a very simple "face sheet" that allows us to identify the claim. We then pull the claim from the portal and proceed with our audit process. We send out daily progress reports on every claim we are managing for you. When the claim audit is finalized, we upload the findings into the same portal for you to retrieve. That data then resides on "your" client specific portal for future use if needed. That's really all there is to it, the process could not be simpler.