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Medical Bill Review

Medical Bill Review

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

Whether our clients take advantage of our automated Claims Editing service or our more intensive Line-Item Bill Review and Claims Auditing, they see a return on their investment with substantially lower bills.

Importantly, we provide appeal support from day one to the ultimate resolution of the claim with the provider.
Claims Editing
HHC utilizes Claims Editing to identify costly errors on claims of all sizes from hospitals, physicians, or any other medical providers.

With hundreds of billing systems, thousands of procedure codes and millions of code combinations, it's no wonder approximately 40% to 70% of medical claims contain errors. With our Claims Editing service, we use automated systems to identify errors such as duplicate entries, improper modifiers 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. Should a provider challenge any of the edits, appeal support is provided from day one at no extra charge.
Line-Item Bill Review
For large dollar amount claims both in-network and out-of-network our clients utilize our Line-Item Bill Review service, a more intense Medical Bill Review approach. Unlike Claims Editing, which employs advanced automation, our line-item review service is performed by high-experienced nurse coders who scrutinize every line on the claim to identify errors such as duplicate charges, improper modifiers and unbundling. We start with a free pre-screen to determine if the potential savings are significant enough to justify an in-depth review. Once again, should a provider challenge any of the edits, appeal support is provided from day one at no extra charge.
Claims Auditing
Like Line-Item Reviews, clients typically use our Claims Auditing service for large dollar claims. At HHC, we utilize registered nurses, who have earned the certified professional coder designation, to conduct claim audits. They examine 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 other erroneous charges.
DRG Validation
The DRG (diagnosis-related group) indicated on a medical bill determines the cost of care. However, our experience is that approximately one in five claims has the wrong DRG. At HHC, our DRG Validation service relies on an examination\review of the diagnostic and 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.

For a more in-depth analysis, send us the patient's medical record. We will have our certified coders recode the claim based on the medical records, and advise you as to how the claims should have been coded and the price difference between the providers coding and our analysis. You can compare the coding for yourself and once you agree, we will be happy to contact the provider to discuss how and why they coded the claim as they did? Additional fees apply for this service.

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