Medical Bill Review

HOSPITAL BILL REVIEW/NEGOTIATIONS

Our Hospital Bill Review services have been very successful in assisting our clients with determining appropriate payment as well as negotiating where other savings are not available or are negligible.

This professional review provides valuable information in a concise format and includes:

  • Timely turnaround
  • Knowledge and experience with state laws governing Workers Compensation and Auto
  • Negotiation services within your parameters
  • Evaluation for unrelated charges, diagnosis, severity of illness, and intensity of service
  • Identification of inaccurate or medically inappropriate charges
  • Dispute resolution

PROVIDER BILL REVIEW

Our Provider Bill Review services construct an analysis of provider bills where medical issues must be considered in evaluating the provider’s services.

  • Maximizes cost savings
  • Considers duration and appropriateness of treatment, diagnosis, intensity of service, unrelated charges and medical necessity
  • Recommends peer review when appropriate
  • Identifies bundled or unbundled charges, experimental treatment, unusual billing practices and inappropriate use of CPT codes
  • Provides savings on recoded multiple surgical procedures

PREFERRED PROVIDER ORGANIZATION

The Preferred Provider Organization services include physicians, facilities, providers, home health services, pharmacy and durable medical equipment. Providers are screened for quality of service, price, and accessibility. Use of these providers results in additional savings to you beyond the state fee schedules and beyond usual and customary prices.

  • Pre-negotiated contractual savings
  • PPO discount applied during bill repricing process
  • Names of out-of-network providers may be submitted for solicitation to join PPO
  • Employer may choose to use listing of PPO members to direct care (in jurisdictions where this is appropriate)
  • Pharmacy Direct Pay PPO service available

MEDICAL BILL REVIEW/REPRICING

Our Medical Bill Repricing service is an automated process that gives you the tools to make appropriate payments on medical bills, whether the bills are for workers compensation or auto claims. Appropriate payments are identified utilizing applicable state fee schedules as specified by state laws, and by a Reasonable and Customary database (built on a defensible national database based on geo-zip codes).

  • Timely bill turnaround
  • Application of Preferred Provider Organization contracts
  • Identifying questionable diagnostic codes through the use of Experienced Bill Reviewers, who scrutinize procedure codes and bills requiring additional review
  • Experienced Registered Nurse available for assessment
  • Retention of two-year history, providing foundation for checking bill duplication
  • Formal reconsideration process
  • Savings analysis reports

MEDICAL BILL DATA EXCHANGE OPTIONS