Patient Accounting Systems and Payment Variance Programs

Stand-alone payment variance tools and similar programs that are components of patient accounting systems can be a valuable part of auditing contractual payments. However, sole use of a software program to identify payment variances puts providers at risk for losing substantial reimbursement.

When these systems are used in conjunction with a review of payments by an independent third party, providers are likely to collect substantial additional reimbursement. In fact, an industry best practice is to use a payment variance program and to engage a separate firm to conduct a zero balance review. This approach will:

• Identify limitations of a provider’s variance tool;
• Collect dollars not found by a variance program; and
• Supplement the efforts of the providers’ internal staff.

Here are some of the frequently used systems and programs that help
identify payment variances:

• Concuity
• Cymetrix
• Ernst & Young
• EPIC
• IDX
• Kreg Information Systems
• McKesson/PCON/Pathways
• MedAssets (Accuro/IMaCS)
• Meditech
• MPV
• PMMC
• Quadex
• SureDecisions
• TPMS/Harvest