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Medical Bill Review

HHC's Medical Bill Review services help reduce clients' claims liability by identifying errors, omissions, and inappropriate charges. In the process, we identify potential fraud, waste, or abuse.

Whether you take advantage of our automated Claims Editing service or our more intensive Line-Item Bill Review and Claims Auditing, you'll see a return on your investment with lower bills.

Medical Bill Review…
  • Ensures the amount you pay is appropriate
  • Identifies unfair billing practices
  • Eliminates duplicate services
  • Identifies non-compliant claims
  • Includes 100% appeal support
Claims Editing

With hundreds of billing systems and tens of thousands of procedure codes, it's no wonder approximately 40% to 70% of medical claims contain errors. With HHC's Claims Editing service, we use automated systems to identify these errors such as duplicate entries and unbundled charges. That's when a provider bills for an inclusive price for a set of services and then charges for the same services individually.

Claims Editing is used for claims of all sizes and for bills from hospitals, physicians, or any other medical provider.

Line-Item Bill Review
For large dollar amount claims – both in-network and out-of-network – clients may utilize our Line-Item Bill Review service, a more intense Medical Bill Review approach. Unlike Claims Editing, which uses advanced automation, our line-item review service is performed by high-experienced nurse coders to identify errors, duplicate charges, and unbundling.

Claims Auditing
Like Line-Item Reviews, clients typically use our Claims Auditing service for large dollar amount claims.

At HHC, we utilize registered nurses, who have earned the certified professional coder designation, to conduct claim audits. They look at the patient's medical records to ensure the services on the bill are consistent with those delivered by the clinical care team. In addition, with a thorough examination of the patient's medical records, they can also identify charges for unnecessary care and erroneous charges.

DRG Validation
The DRG (diagnosis-related group) indicated on a medical bill determines the cost of care. However, approximately one in fifteen claims have the wrong DRG. At HHC, our DRG Validation service relies on an examination of the procedure codes within the claim to determine the correct DRG. Once we determine the proper DRG, we compare it to the DRG on the medical bill to ensure consistency. If they don't match, we determine the reimbursement for both DRGs and allow the client to determine how to proceed with payment.

Our Medical Bill Review services may be used independently or with other HHC services to achieve maximum savings. Contact HHC today to learn more.