Bill review companies save payors millions of dollars in health care fees every year. A recent audit by the General Accounting Office of the Federal Government found overcharges on 95% of provider bills. Charges for treatment of work related injuries are regulated by law in every state in the U.S., yet less than 1% of health care providers bill their services at the statutory rates.
A COMPLEX PROCESS
Reviewing and re-pricing a medical bill is a technical procedure that requires skilled personnel and sophisticated software to take every allowable reduction. There are over 7,000 five-digit codes used for health care services and procedures. This makes it impossible to validate charges manually. Because there are so many facets involved in the
re-pricing of a bill, it is best handled by technical and health care experts using specially developed software.
HOW CHARGES ARE REDUCED
When a bill is reviewed, our company looks at numerous possibilities for reducing your fee. Some of the most common are:
FEE SCHEDULE: Providers bill more than the law requires you to pay for treatment of occupational injuries. The procedure is compared against the state fee schedule and reduced accordingly.
UPCODING: Providers will often charge for their services using a code which pays more than the minimum necessary for treatment. They will code the procedure “up” to receive a higher fee. Our system reclassifies the procedure and reduces the charge.
UNBUNDLING: Routine procedures are sometimes broken down into separate parts – each charged at a rate higher than the appropriate code which “bundles” and consolidates the fee at a lower cost.
DISALLOWED ITEMS: We look for and deny payment of charges for items not required for the injury described or those that are confusingly named, such as “thermal therapy kit” (ice cubes), or “urinal” (plastic cup).
DURABLE MEDICAL ITEMS: Some fees are ambiguous, such as “wrist brace.” There may be more than a dozen types of wrist braces. In most cases you will be charged for the most expensive model. We quickly research the appropriateness of the equipment for the nature of the injury using a special look-up data base in our system. We make sure you only pay the minimum amount required.
DUPLICATE BILLS: Have you already received (and paid) this bill? There may also be partial duplicate bills. Our system tracks the claim, procedure and date of service automatically.
UNAUTHORIZED CHARGES: Our sophisticated software allows claim examiners or nurse case managers to “flag” claims to insure billing does not exceed the parameters of the patient’s treatment plan.
CONTRACT DISCOUNTS: Many hospitals and service providers belong to Preferred Provider Organizations – PPOs. As such, they have agreed to treat for a fee that is less than the regulatory schedule. Once again, they do not render bills at the discounted rate. Our software contains the latest PPO contract rates and applies discounts automatically. In addition, we “stack” PPO networks to customize your discounts – by researching the best contract rates for geographic areas.
Negotiated Discounts: In the absence of a fee schedule or PPO discount, our staff of negotiators will contact the service provider to arrange a fee reduction in exchange for prompt payment. We have secured negotiated discounts of up to 35%, in one case, saving a client over $400,000 on a single transaction. This type of service takes bill review to a new level.
TURNAROUND TIME is the length of time it takes for a bill to be returned to the payor once it has been received by the bill review company.
In many states, a workers’ compensation bill must be paid within 30 days of receipt or there are legal consequences. In some cases, no reduction may be taken after 30 days, in others, a financial penalty can be imposed. Our workflow tracking process insures a turnaround time of 72 hours or less. Prompt, reliable processing and delivery must be an integral part of bill review service.
SOFTWARE INTERFACES are huge time savers. We have developed data import/export programs for every major claim software system. Bill review data can be automatically populated to the claim file saving time, clerical expense and eliminating errors.
CUSTOM REPORTS are a very important tool for managing your cost containment program. It is imperative that a bill review company provide you the ability to perform frequency and cost analysis reporting for:
Our Windows™ based software makes it easy to export data to any popular spreadsheet or word processing program.
Finally, there is the consideration of ongoing customer service. A single point of contact who is dedicated to your business provides immediate answers to your questions and quick resolution of problems. This is the basis for a long-standing business partnership.