Medical Bill Review
On average, we reduce 15%-25% of annual billed charges by removing billing errors and invalid or non-compliant charges, prior to the application of a network contract.
Our review is performed by clinicians and coding experts with advanced certifications and degrees. We identify errors and non-compliant charges per federal, state and commercially accepted billing guidelines. We review claims for medical necessity and offer legal reviews regarding adherence to PPO contracts and plan documents. The end results of your partnership with HPC are Clean Claims that adhere to your Plan Docs and PPO contracts. This results in an overall reduction in plan cost through the reduction of errors. We back up our work with clinical coding and legal defense for the patient and the plan.
Specifically, we look for items that are non-compliant with the following:
Social Security Act
Code of Federal Regulations
Uniform Billing Act
False Claims Act
CMS Manuals
State Laws
National AMA and AHA Rules & Guidelines