Performant’s 10 years of experience in the healthcare market providing audit and recovery services related to improper payments began in 2009 with our first Centers for Medicare and Medicaid (CMS) Recovery Audit Contractor (RAC) contract . In October 2016, Performant was awarded two new CMS RAC contracts. One award includes Parts A and B Medicare payments in an 11-state region in the Northeast and Midwest. The second award involves post-payment review of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and home health and hospice claims nationwide. Then, in October 2017, CMS awarded Performant the national exclusive Medicare Secondary Payer (MSP) Commercial Payment Center (CPC) contract.
Through our technology-enabled services platform, Performant screens Medicare claims against several criteria, including coding procedures and medical necessity standards, to determine whether a claim should be further investigated for recoupment or adjustment. Conducting automated and, where appropriate, detailed medical necessity reviews, Performant determines whether the likelihood of identifying a potential improper payment warrants further investigation. Experts in Medicare coding, as well as registered nurses, request and review healthcare provider medical records related to the claim and, ultimately, submit the claim to CMS.
In the private healthcare market, our platform is deployed to provide audit, recovery, and analytical services for private healthcare payers. Capitalizing on our RAC contract experience, Performant has established a presence in the private healthcare market providing audit and recovery services for several national commercial health plans. Our audit and analytics capabilities have not only allowed Performant to expand our services with these initial private healthcare clients, but also to enter other related private healthcare opportunities.
Following Performant’s acquisition of Premiere Credit of North America, LLC in August 2018, our suite of healthcare solutions now also provides revenue cycle management solutions to hospitals and other healthcare providers.