HMS, Inc., (“HMS”) a wholly owned subsidiary of HMS Holdings Corp. (NASDAQ:HMSY), announced the launch of a new prepay clinical review solution, the Company’s latest addition to its payment integrity product suite.
HMS, with its affiliates, has been the national leader in the identification and recovery of improper payments on a postpay basis, recovering hundreds of millions of dollars annually for government and commercial healthcare payers. Now the Company is applying its proprietary algorithms, sophisticated technology platform, and specialized workforce to identify potential payment issues on a post-adjudication, prepay basis.
“In response to the industry’s move to payment models centered on outcome-based episodes of care, HMS is proud to be first to market with a prepay solution for clinical reviews,” said Spencer Young, Senior Vice President of Clinical Solutions. “The solution builds on our track record of success in postpay clinical reviews, and leverages our unique targeting process to maximize findings for payers while minimizing the burden on providers. This is the next step in helping payers shift from recovery approaches to higher-value prepayment models.”
Young added, “With our prepay solution, payers will capture a high percentage of the potential errors because they’ll be paying claims accurately in the first place, rather than recovering retrospectively. There can be a significant financial upside for payers, since not all postpay findings are recovered.”
HMS will present the new solution at the National Healthcare Anti-Fraud Association Conference in Dallas from November 18–20.
About HMS Holdings Corp.
HMS Holdings Corp., through its subsidiaries, is the nation's leader in coordination of benefits and program integrity services for healthcare payers. HMS's clients include health and human services programs in more than 45 states; commercial payers, including group health plans, Medicare Advantage Plans, more than 160 Medicaid managed care plans, and employers; the Centers for Medicare and Medicaid Services (CMS); and Veterans Administration facilities. As a result of the company's services, clients recovered over $3 billion in 2013, and saved billions more through the prevention of erroneous payments.
Safe Harbor Statement
This press release contains “forward-looking statements” within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. Such statements give our expectations or forecasts of future events; they do not relate strictly to historical or current facts. Forward-looking statements can be identified by words such as “anticipates,” “estimates,” “expects,” “projects,” “intends,” “plans,” “believes,” “will,” “target,” “seeks,” “forecast” and similar expressions and references to guidance. In particular, these include statements relating to future actions, business plans, objectives and prospects, and future operating or financial performance. Forward-looking statements are based on our current expectations and assumptions regarding our business, the economy and other future conditions. Should known or unknown risks or uncertainties materialize, or should underlying assumptions prove inaccurate, actual results could differ materially from past results and those anticipated, estimated or projected. We caution you therefore against relying on any of these forward-looking statements.
Factors that could cause or contribute to such differences include, but are not limited to: variations in our results of operations; changes in the U.S. healthcare environment and steps we take in anticipation of such changes; regulatory, budgetary or political actions that affect procurement practices; our ability to retain clients or the loss of one or more major clients, including through our failure to reprocure a contract or the reduction in scope or early termination of one or more of our significant contracts; our ability to effectively manage our growth to execute on our business plans; the risk that guidance may not be achieved including but not limited to the risk that we may not achieve non-Medicare margin expansion; the risk that HMS will not receive a contract award for any current or future procurement or reprocurement or that either or both may be delayed; the risk of negative or reduced growth rate of spending on Medicaid/Medicare, simplification of the healthcare payment process or programmatic changes that diminish the scope of benefits; the risk that CMS may not support the RAC program, may change the RAC program and reduce future fees, and may require repayment of certain prior fees; our ability to retain clients or the loss of one or more major clients; client dissatisfaction or early termination of contracts triggering significant costs or liabilities; the development by competitors of new or superior products or services; the emergence of new competitors, or the development by our clients of in-house capacity to perform the services we offer; all the risks inherent in the development, introduction, and implementation of new products and services; our failure to comply with laws and regulations governing health data or to protect such data from theft and misuse; our ability to maintain effective information systems and protect them from damage or interruption; restrictions on our ability to bid on/perform certain work due to other work we currently perform; our ability to successfully integrate our acquisitions; our ability to continue to secure contracts through the competitive bidding process and to accurately predict the cost and time to complete such contracts; our compliance with the covenants and obligations under the terms of our credit facility and our ability to generate sufficient cash to cover our interest and principal payments thereunder; and negative results of government or client reviews, audits or investigations to verify our compliance with contracts and applicable laws and regulations; or the risk that savings for plans or capture of findings will not be as expected.
A further description of these and other risks, uncertainties, and related matters can be found in our Annual Report on Form 10-K for the fiscal year ended December 31, 2013, which is available at www.hms.com under the “Investor Relations” tab. Factors or events that could cause actual results to differ may emerge from time to time and it is not possible for us to predict all of them. Any forward-looking statements are made as of the date of this press release and we do not undertake an obligation to publicly update forward-looking statements, whether as a result of new information, future events or otherwise, except as may be required by law.
Contacts:
fmarraro@hms.com
