HMS HOLDINGS CORP.

HMS HOLDINGS CORP.

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Company Overview
HMS Holdings Corp., founded in the year 1974, operates as the parent company of both Health Management Systems and Reimbursement Services Group. A publicly traded company (NASDAQ: HMSY) since December 1992, HMS Holdings, is devoted to helping healthcare concerns throughout the U.S.
HMS Holdings is based in New York. The company’s service offerings benefit its clients by enhancing revenue and reducing costs. Health Management Systems (HMS) is the strategic source for innovative revenue recovery and cost containment solutions that benefit public healthcare, serving the state and county programs, as well as Medicaid managed care plans. Using state-of-the-art information management and processing technology, HMS offers scalable services-from supplemental to full outsourcing-to help clients make efficient, appropriate use of public healthcare funds.
Reimbursement Services Group (RSG Inc.) provides Medicare reimbursement services to some of the largest public and private hospitals throughout the country. Through a powerful combination of data warehousing, analytics and Medicare program knowledge, RSG delivers outstanding results. Clients receive additional reimbursement dollars, insight into their processes to maintain compliance, and feedback regarding business office practices. Services include: medicare bad debt reimbursement, medicare bad debt compliance review, medicare disproportionate share reimbursement, ESRD reimbursement, audit support services, and REaP proprietary analytics and reporting.
Business Summary
HMS Holdings Corp. (HMS) provides a variety of cost containment, coordination of benefits and program integrity services for government-sponsored health and human services programs. The Company’s clients are state Medicaid agencies, government-sponsored managed care plans, Pharmacy Benefit Managers (PBMs), child support agencies, the Veterans Health Administration (VHA), the Centers for Medicare & Medicaid Services (CMS), commercial plans, self-funded employer plans and other healthcare payors. In September 2009, it acquired IntegriGuard LLC an International Organization for Standardization (ISO) certified and Utilization Review Accreditation Commission (URAC) accredited organization, which provides services related to the prevention and detection of fraud, waste, and abuse in the healthcare system. In December 2009, HMS acquired the assets of Verify Solutions, LLC. In September 2010, the Company acquired Chapman Kelly.
Description and history
HMS Holdings Corp. (HMS), incorporated on October 2, 2002, provides a variety of cost containment, coordination of benefits and program integrity services for government-sponsored health and human services programs. The Company’s clients are state Medicaid agencies, government-sponsored managed care plans, Pharmacy Benefit Managers (PBMs), child support agencies, the Veterans Health Administration (VHA), the Centers for Medicare & Medicaid Services (CMS), commercial plans, self-funded employer plans and other healthcare payors. In September 2009, it acquired IntegriGuard LLC an International Organization for Standardization (ISO) certified and Utilization Review Accreditation Commission (URAC) accredited organization, which provides services related to the prevention and detection of fraud, waste, and abuse in the healthcare system. In December 2009, HMS acquired the assets of Verify Solutions, LLC, a company specializing in dependent eligibility audit services for large and mid-market employer-sponsored healthcare plans. In September 2010, the Company acquired Chapman Kelly.

Coordination of benefits services route claims already paid by a government program to the liable third party, which then reimburses the government payor. The Medicaid and Medicare programs, including Medicaid and Medicare managed care organizations, and VHA must all coordinate benefits with other payors to ensure that claims are paid by the entitlement program, group health plan or other party that actually bears responsibility for a particular incident of medical service. Cost avoidance services provide validated insurance coverage information that is used by government payors to reject claims that are the responsibility of a third party, typically a group health plan sponsored by a beneficiary’s employer. Child support agencies use this information to identify children who have coverage from either the custodial or non-custodial parent, as well as to identify children without coverage.

Program integrity services are designed to ensure that medical services are utilized, billed, and paid appropriately. It identifies payment errors, and then recovers the erroneous payments, if appropriate. Its program integrity services include data mining; credit balance reviews; clinical reviews; fraud, waste, and abuse detection, and recoupment services.

Business Line
Operates as the parent company of both Health Management Systems and Reimbursement Services Group
Subsidiary
CHAPMAN KELLY INC
Advisor
KPMG LLP
IPO date
12/1992
US SIC Code
8011
Company Address
401, Park Avenue South

City province or state postal code
10016, NEW YORK, NY
Phone: +1 212 725 7965
Fax: +1 212 857 5973
Country address: UNITED STATES OF AMERICA
Website url: www.hmsholdings.com