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Third Party Medical Bill Audit

Definition: A review of medical bills with appropriate reduction to state fee schedule or reasonable and necessary rate, culminating in a comprehensive report.  The review is provided by a registered nurse discerning medical appropriateness, level of service and coding protocols.

 Features:

      Comprehensive review by a nurse with coding certification

      Time-line of treatment

      Utilization recommendations

      Pricing recommendations

      Containment recommendations are documented where appropriate and requested

      All bill types reviewed

      Clear table of recommendations; not a confusing  Explanation of Benefits

      Negotiation services available

      Customizable service and reporting

 

Benefits:

      Prevents payment of fraudulent claims

      Delineates rationale for cost control of medical expenses

      Identifies duplicative service charges

      Produces documentation for appropriate reductions

      Determines whether or not services are provided by appropriately licensed individuals

      Assures treatment is medically necessary based upon evidenced based treatment protocol

      Control of medical expense and service use

 

Cost:  Hourly charges regardless of amount saved versus the 20 to thirty percent of savings charged by most bill review companies.  Charges are mutually agreed upon.

 

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114 W. Market Street Mount Carroll, IL 61053   -   Ph: (815) 244-1330  -  Fax: (815) 244-1322
info@NurseValue.com

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