Medical Bill Review Services
Finding Medical Bill Review services are essential for risk managers. In other words, it is applicable at property and casualty, auto insurance, and health insurance companies. Our medical bill review cost reduction solutions ensure accurate repricing. To clarify this maximizes savings, and allows clients to make intelligent payment decisions.
Data, Regulations, Technology, Economics, Experts in Paper to Electronic and litigation support
That is to say that, our Medical Bill Review programs utilize :
- Data and coding integrity checks
- Audits for adherence to Industry Standard data
- Audits for supporting documentation including chart reviews
- Cloud electronic technology with payer and electronic health record integration
- Backed by expert opinions
- National and regional pricing data, adjusted for Industry Standard wage indices
- See program offerings for more information
Return on Investment
Furthermore, Return on Investment of Medical Bill Reviews at $10 to $70 per $1 in medical bill review fees. Additional potentially higher returns for chart reviews, audits, and claims analytics including de-duplication.
To elaborate, data integrity is the first crucial step in our bill review process. We ensure data accuracy through redundancy, automated scrubbing, dynamic logic, and manual intervention as appropriate.
Complete Solution from Review, Repricing, and Expert Witness Litigation Consulting
Above all, our national and local experts review charges and insurance payment data for:
- Outpatient ICD-10 diagnosis and medical procedures using diagnosis, CPT and HCPCS coded procedures
- Inpatient hospital bills including DRG validation
- Ambulatory surgery centers including facility fees
To emphasize accuracy, we use data quality checks. This means that we can evaluate clinical documentation and coverage policies. With diagnosis and procedure data, we review medically necessary care. Our analytics helps maximize savings.
Most important are our people. Our medical bill review team includes physicians, RNs, medical coders, and experts affirmed by Federal and State Judges. If negotiations are inconclusive, we can give testimony as to reasonable and customary charges in court.
We are experts in Medicare billing standards and CMS medical bill review procedures. We are experts in independent bill review (IBR) for workers compensation.
Bill Review Program Offerings
|Medical coding review which includes checks for unbundling. We check modifiers, place of service appropriateness and National Correct Coding Initiative (NCCI) edits|
|Claim scrubbing and adjudication simulations|
|Payor policy reviews|
|Medical bill repricing|
|Automatic fee schedule and adjustments required by Medicare Administrative Contractor (MAC) jurisdiction or State statutes|
|Usual, customary and reasonable review|
|In-network and out of network considerations|
|Analytics to detect duplicate bill detection with high accuracy|
|Fraud detection (especially when chart reviews are performed as part of the scope)|
|Medical Specialty bill reviews|
|HIPAA Security Rule compliant cloud-based electronic portal for medical bill approval and reports access|
|Out of network settlement platform|