Hospital Bill Audits
Extraordinary claims require extraordinary evidence.
Our Hospital Bill Audits are independent, line-by-line reviews of inpatient hospital claims identified as posing a significant financial risk to our clients. These audits apply to Total Billed Charges, Percentage of Billed Charges and Cost Outlier payments.
MedReview offers independent hospital billing audits that include a line-by-line review of the itemized bill and corresponding medical record. Each line item is validated to ensure that all services rendered were documented in the record, ordered by the physician and deemed medically appropriate. For Cost Outlier payments, we also validate the DRG coding using our proprietary physician-led clinical audit process.
Analyzing complex hospital billing issues requires specialized expertise and resources. That’s because many payors do not have the internal staff and experience to quickly and accurately identify errors and deconstruct the clinical, network and coding nuances inherent to hospital bill audits. MedReview’s registered nurses have the expertise and experience to ensure that all charges indicated on claims match the actual care and services delivered.
MedReview’s Hospital Billing Audits focus on:
- Items and services to determine if they are duplicative or billed incorrectly.
- Non-validated charges to verify if the services billed match services rendered.
- Unbundling of routine items and services.
- Level of care in accordance with Milliman or InterQual Care Guidelines.
- Health plan policies to ensure charges meet policy guidelines.
Over 2.5 million claims reviewed.
At the forefront of the latest advances in artificial intelligence (AI), MedReview accelerates the review processes by using proprietary algorithms to pour through enormous amounts of data in a blink of an eye, automatically recognizing patterns in data sets, analyzing hospital bill audits and identifying incorrect or potentially abusive claims.