Medical Bill Auditing/ Re-pricing:

 

Medical Bill Auditing and Re-pricing is a cost management tool that can be used by automobile and worker's compensation carriers and attorneys to determine the appropriate charge for services rendered by a treating provider before paying bills or to define out-of-pocket expenses. 

 

• Medical bill audits and re-pricing are completed within 7-10 business days.

 

• Rush line by line re-pricing requests may be faxed and reports can be completed within 24-48 hours as needed.

 

•  All bills are re-priced according to ACT 44 (Worker's Compensation) or ACT 6 (Pennsylvania Automobile).

   

• Our nurses also analyze the bills for any discrepancies inappropriate unbundling of charges, duplicate charges, proper CPT coding and questionable charges and services. 

 

• Based on our clients Worker's Compensation physician panels our nurses analyze the bills to ensure that the claimant has treated with a panel physician within the first 90 days of the injury.

 

• The Explanation of Benefits (EOB) will list line numbers, procedure code, description of CPT code, actual charge, reduction amount and allowed amount.  The EOB will also list any variation in calculation of those charges. 

 

• Attempt to negotiate  prompt-pay discounts from hospitals for Workers' Compensation carriers

 

• Out of state provider bills without re-pricing guidelines or CPT codes are re-priced at 80% of the Usual and Customary charges. 

 

• A copy of the Explanation of Benefits is attached to the corresponding provider billings for quick reference