Bill Review

The Bill Review Service includes Physician and Hospital Bill Review, Surgical Cost Estimate and PPO Repricing offerings. The service offerings examine the specific medical care rendered and how its relevance and cost conform to industry accepted standards of care. The services are evidence-based, defensible and durable because they are prepared in accordance with industry guidelines and consistent with most jury instructions. Straightforward in their simplicity and understated in their power as an effective negotiation tool, the Bill Review Services repeatedly prove invaluable.

Physician Bill Review

The Physician Bill Review is used to facilitate the adjudication, settlement or resolution of a medical bill or claim. It provides an unmatched standard for compensability relative to “reasonable and necessary medical expenses.” The Physician Bill Review targets several categories in which charges can be unnecessary, excessive, duplicate or inaccurate. A line item audit is performed for every charge on the bill. The Physician Bill Review Service adds an increased degree of relevance, authenticity and accuracy because it is based on rates for services based on local market data.

Hospital Bill Review: Line Item Audit

The Hospital Bill Review is used to facilitate the adjudication, settlement or resolution of a hospital bill or claim. ExamWorks offers two types of Hospital Bill Reviews: Line Item Audit and File Audit. Hospital Bill Reviews are performed under the supervision of licensed clinical staff to ensure that clients have the necessary data to demonstrate that their payment decisions are based on national billing practices, industry guidelines, relevant state regulations as well as appropriate usual and customary pricing. Each bill associated with the claim is audited against commonly accepted industry standards and databases to determine the legitimacy of every charge.

Hospital Bill Review: File Audit

The Hospital Bill Review File audits the all hospital records. The report provided includes a summary by a Registered Nurse (RN) that outlines the services areas targeted for reduction, the recommended dollar amounts and the overall percentage reduction of the bill. The RN compares the charges in an itemized billing on a line-by-line basis with information contained in the corresponding medical records. By reviewing the medical records, clients are assured that the audit is comprehensive and exhaustive, identifying all potential billing errors are detected, recorded and corrected.

Surgical Cost Estimate

The Surgical Cost Estimate outlines specific medical treatment options, therapy and rehabilitation. It provides a detailed explanation of any surgical procedure. In addition to the description of the procedure, the Surgical Cost Estimate provides averages for the rehabilitation and disability timelines. Using state-of-the-art medical bill review data source, the Surgical Cost Estimate provides “usual, customary and reasonable” costs associated with the procedure itemized by service category. The service, performed by credentialed RNs, is effective because it highlights ways in which costs can be anticipated, managed and reduced, especially in cases with an increasing medical severity.

PPO Repricing

Based on strategic partnerships with several of the nation's largest PPOs, PPO Repricing Service ensures that maximum coverage and savings can be realized. Currently, the PPO Repricing Service offers access to data from a large network of hospitals and providers, more than 75,000 facilities, including hospitals and 550,000 physicians in the U.S. Repriced services realize substantial discounts and cost reductions, contributing to another level of strategic medical cost containment.