GENERAL QUESTIONS

What is FIT?
FIT is a new, automated approach to performing edits and exception analyses on patient claims.

FIT stands for:

Find Income

Improve Profit

Tighten Controls

How does it work?

It’s important to know that HWC does all the work. HWC takes data, straight from the hospital information system or IT vendor. We load the contract terms, and then input them into the “Pricer.” Each account is grouped and re-priced to reflect the exact contractual rate.  Enhanced data is loaded into a relational database. An “edits and exceptions” analysis is run - comparing what the hospital billed and/or got paid versus the FIT price.  Billing opportunities are researched, confirmed, billed and collected.  Because FIT is an automated process, each and every case can be reviewed.

What is the "Pricer?"

The “Pricer” is a powerful tool that gives your hospital the benefits of contract management, but at a fraction of the cost. The “Pricer” allows every nuance of your managed care contracts and regulatory rate structure to be considered in your revenue entitlement calculations. And because the “Pricer” maintains current and historical contract terms, it can retroactively calculate hospital revenue entitlements on a patient-by-patient basis. This feature is what makes FIT so effective in finding additional billing opportunities on closed or “zero balance” accounts.

What is the "confirmation" process?

Once HWC has priced your accounts and performed our edits & exceptions analysis to locate underpayments, we prepare a report of our findings.  We then confirm these findings by checking the hospital data to make sure that these discrepancies have not already been identified by hospital staff or other vendors.  Depending on the client, we may also take this opportunity to sit down with hospital personnel to discuss our findings.  Often our findings can be used as a teaching tool for hospital staff, and of course, we want to ensure that the accounts we have identified were not covered under some previous blanket settlement with an insurance company.

Is my hospital a good candidate for a FIT review?

If you have managed care contracts that allow billing for "carve-outs" or special rates, you most likely will benefit from a FIT review.  However, our most successful FIT reviews have been in tertiary facilities that have specialty services such as cardiac, orthopedic, neonatal, etc.  And, although HWC can interface with virtually any system, implementations go especially smoothly at Siemens Invision Remote Computing Option (RCO) installed hospitals.

Will the FIT process disrupt my business office?

As FIT is an automated process, the disruptive activities normally associated with a "managed care account review" are unnecessary with FIT.  Normally we have everything we need (i.e. data and contracts) in our office and we can do virtually all of our work off site.

What are the fees?

Our fee is normally contingent upon actual cash collected by HWC for our clients.  Some hospitals have asked for alternative pricing scenarios and we have complied.  Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call us at 1-888-hwcsoft for more information.

TECHNICAL QUESTIONS

How does FIT handle medical denials?

This is a common question, as our clients don't want to be bothered by reviewing "findings" that turn out to be unbillable.  In the case of denials, HWC has all the transaction level data it needs to identify denial allowances in the system; we exclude denied amounts from our findings.  In the case of a hospital who hasn't posted all of their denial allowances, HWC has all the contracts and has built edits into the system that help us ensure that the discrepancies between our calculated amount and the hospital information are true underpayments.  For example, discrepancies that are exactly equal to, or multiples of, one day at per diem rates usually indicate an unposted denial allowance.  We also check the account notes for evidence of a denial.  Don't worry, we identify the vast majority of denial exceptions and delete them long before we present our findings to you.

Can FIT resolve administrative (technical) denials?

The resolution of technical denials can be included in a FIT engagement upon request.

What if my hospital has already performed a managed care review?

It is often the case that HWC will perform its FIT review after some kind of a managed care review has already been performed by the hospital or an outside vendor. To avoid duplication of efforts, HWC checks the notes on each FIT-identified account for prior activity that may be related to our finding.  If the earlier review was performed "off the system," HWC merely asks that we be given a list of the issues that have already been identified.  We will delete them from our report.  The same goes with any ongoing reviews; we can use a confirmation meeting to coordinate our efforts and avoid duplication of work.

How can my hospital be assured that you will not identify and pursue accounts that have already been part of a previous settlement?

In some cases HWC will perform its FIT review after the hospital has settled with a managed care company on a group of accounts.  Just provide us a list of the accounts affected or some other way of identifying them (i.e. diagnosis, time period, plan code). We will delete them from our report.

What about multiple plan types within a payer?

HWC knows well that there may be multiple plan codes within a payer and that they may all pay differently.  Our consultants carefully study each of your contracts before they are input into the "Pricer."  The pricer accurately maps every nuance of your contract terms to arrive at an accurate price according to the payer contract and individual plan code.  In the case of atypical payments, account pricing is reviewed for correctness across payer types during the confirmation process.

Does FIT identify underpayments by silent PPOs?

The identification and pursuit of underpayments by silent PPOs can be included in a FIT engagement upon request.

Our hospital uses the Siemens system, how do you review and confirm "archived" accounts?

HWC's FIT Data Warehouse has ALL of your accounts live and on-line.  We often have the notes as well.  As a last resort, we will reactivate an archived account through the Siemens system, but only to ensure that there has been no duplication of effort.

May we review your findings before you bill?

Our clients occasionally ask for a meeting during the confirmation process to review our findings, both as an accuracy check and as a possible learning opportunity for their staff.  That's fine with us - as long as we keep the billing and collection process moving along.

Does FIT include follow-up on billed accounts?

It would be nice, wouldn't it, if insurance companies would just pay the bills presented them?  We all know that that is not the case; sometimes the reasons are legitimate, sometimes they're not.  The FIT process includes follow-up through account adjudication, including the sending of appeals on accounts that have been denied for timely filing.

What about accounts other than managed care cases?

The FIT process includes the re-pricing of EVERY ACCOUNT in your patient file.  Remember, workman's compensation accounts sometimes allow billing of "carve-outs."  And some indemnity plans pay certain accounts through a managed care PPO scenario.  There are other benefits to the re-pricing as well, including the ability to arrive at an accurate Net Realizable Value of the AR.

How about complaints from managed care companies?

Would you believe that after billing thousands of accounts in dozens of hospitals that we have never had a SINGLE complaint from a managed care company?  But if we ever do, you can be sure that we will work with our client hospital to resolve it IMMEDIATELY and to the total satisfaction of both the provider and the payer.

Who pulls the UBs?

Sometimes HWC pulls the UBs (or prints copies); sometimes the hospital does from a list provided by HWC.  We will work with you to create a process that works best for the hospital.

Who pulls the invoices for billables (implantables, "trailers," "carve-outs," etc?)

Usually HWC pulls the invoices; sometimes the hospital does.  Again, we will work with you to create a process that works best for the hospital.

Will HWC document their work?

HWC typically puts notes on the client's system that document our activities.  Among other things, this prevents the hospital billing department from refunding unexpected payments that come in due to the FIT program.

How do you handle missing charges?

FIT edits often identify accounts that we know show have a billable, but for which there are no charges on the accounts.  HWC will bring these accounts to the hospital's attention so that charges can be added and a revised UB generated.

Does FIT look only at "zero balance" accounts?

The FIT process includes the re-pricing of EVERY ACCOUNT. We analyze each of them, including accounts that have been paid but have credit or patient balances remaining.  Remember, FIT focuses on UNDERBILLINGS.  Some accounts we identify may have balances, some may not.  Our reporting is excellent, you will have every opportunity to review and understand what and why we bill.

TOUGH QUESTION

How do we know you know what you are doing?

Good question, and an important one.  Our healthcare professionals have decades of experience in healthcare finance and insurance.  Our systems are state of the art and our "Pricer" contract manager is incredibly flexible.  But the answer is that our results speak for themselves.  We have collected tens of millions of dollars for our clients.  Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call us at 1-888-hwcsoft and we'll introduce you to the people who know best: our customers.