Hospital Bill Reviews / Audits

Medical Rehabilitation Consultants hospital bill review/audit program identifies any discrepancies in the hospital services being billed. The hospital bill will be pre-screened to identify any services which will require in-depth analysis. If an onsite review is determined to be necessary, in-depth hospital review is conducted at the hospital. An in-depth review will determine medical appropriateness and relatedness and matching medical records to the bill for services, products, and procedures being billed. If it is determined that the services do not require an in-depth review, a partial review will be conducted. After a review, recommendations will be completed and submitted to the claims administrator for appropriate actions to be performed as part of the reimbursement process.

General Claims Review

A random sample of all claims processed will be reviewed for medical appropriateness and relatedness. Monthly reporting will also identify problem areas with utilization by both providers and patients.

Claim to Bill Audit

A random sample of all claims processed will be reviewed for medical appropriateness, accuracy of information and relatedness.