Pre Payment Claim Audits
MedReview’s Pre Payment Claims Audits identify potential claims overpayments before they have been paid by your Third Party Administrator. 100% of large hospital and physician bills that meet client specific criteria are audited on an ongoing basis.
Healthcare studies show that 7% of all claims account for a significant amount of your healthcare expenditures. When these claims are audited before they have been paid, you will more effectively manage your healthcare dollar.
You may select a performance based fee structure, thereby incurring no financial risk. A fixed fee is also available.
Pre Payment Claims Audit clients have realized average savings of 15% of claims audited!
The Process:
MedReview performs a line by line review of every claim submitted for audit. We make sure that your plan only pays properly billed charges for these claims. The process also results in the payer applying its PPO discounts after the MedReview audit process has been completed, enabling you to maximize your savings on in-network claims.
The MedReview Pre Payment Audit involves two distinct processes.
Step 1: Financial Review: MedReview performs line-by-line comparisons of the supporting hospital and professional claim itemization which is the only valid method to adjust these claims for incorrect billing practices and to confirm that correct standard fees for ‘usual and customary’ areas of treatment, supplies, etc. were paid.
Step 2: Clinical Review: MedReview uses trained medical staff including physicians to provide a detailed review of claims with a certain dollar threshold which you the client, select. This includes a review of the medical records and treatment protocols to make certain that you are only paying for services that were actually rendered.
Our program combines the experience of an on-site medical director, highly skilled nurse reviewers and state-of-the-art medical billing software to achieve lower claim costs and improved claims payment accuracy for both hospital and physician bills.
The MedReview Pre Payment Audit process does not delay payment of the claim by the payer.