Penstock conducted a detailed analysis of a regional Health Plan’s medical claims to evaluate compliance with the applicable requirements of NYS HCRA. Our evaluation focused on regulatory and NUBC changes and cross-claims analysis to identify exclusions currently missed based on stand-alone claim determinations.
In addition to identifying and recovering inappropriately submitted HCRA funds, Penstock was able to provide coding and billing guidance, industry-standard policies and guidelines, and the applicable regulatory references that support operational or system changes required to ensure the accuracy of assessment obligations.
Penstock identified $2,963,502 in surcharge overpayments for the time period under review. By providing the reference documentation and recommendations, the client was able to make systemic changes to prevent future recurrences.
![[Case Study] Medicare Advantage Second-Pass Audit](https://www.penstockgroup.com/wp-content/uploads/2023/08/Meticulous-Second-Pass-Penstock-Audit-Returns-4.8M-to-Medicare-Advantage-Health-Insurer-jpeg.webp)
