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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:
Ø
Comprehensive
review by a nurse with coding certification
Ø
Time-line of
treatment
Ø
Utilization
recommendations
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Pricing
recommendations
Ø
Containment
recommendations are documented where appropriate and
requested
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All bill types
reviewed
Ø
Clear table of
recommendations; not a confusing “Explanation of Benefits”
Ø
Negotiation
services available
Ø
Customizable
service and reporting
Benefits:
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Prevents payment
of fraudulent claims
Ø
Delineates
rationale for cost control of medical expenses
Ø
Identifies
duplicative service charges
Ø
Produces
documentation for appropriate reductions
Ø
Determines whether
or not services are provided by appropriately licensed
individuals
Ø
Assures treatment
is medically necessary based upon evidenced based treatment
protocol
Ø
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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REFERRAL FORM
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