Medical Bill Review

Errors and Non-payable items on Large Claims continue to increase and have exceeded 24% of total billed charged.

HPC Medical Bill 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. Furthermore, we are the only cost containment firm that has created our own Provider Reimbursement Manual, making it easy to defend the removal of non-payable items. With HPC, you receive Clean Claims that adhere to your Plan Docs and PPO contracts. This results in a comprehensive cost containment strategy for the plan. 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