ABOUT

HISTORY

Quality Review Concepts LLC, DBA QRConcepts was founded in 1995 by Marge DiBenedetto and Nancy Cerbone. As experienced Registered Nurses with many years of service to one of the largest NYS Workers' Compensation carriers, Ms. DiBenedetto and Ms. Cerbone were uniquely situated to bring their talents and experience to the larger carrier arena.

With the mission statement, "Excellence, Integrity, Service," QRConcepts was formed as a medical bill auditing company serving the Workers' Compensation and No-Fault carrier communities.

QRConcepts' distinctive auditing methodology resulted in proven and unprecedented savings for their clients. Success led to growth and the addition of more registered nurses and certified medical coders trained in QRConcepts' methodology. Over time, the needs of their clients plus changes to the NYS Workers' Compensation law resulted in an expansion of QRConcepts' basic services.

STRATEGY

Today, their professional staff performs many additional functions in service to the medical aspect of the claim. These can include file reviews, variances, appeal letters, fee negotiation and telephonic nurse case management. Moreover, QRConcepts' clients now have the option to continue to outsource all medical billing or to access this software via a client portal for in-house review. Whichever service path a client chooses or wishes to create, QRConcepts' professional staff is ready, willing and able to meet the needs of the medical claim.

QRConcepts' continued expansion includes new proprietary software that applies the NYS WC Medical Treatment Guidelines for each claim while tracking treatment and outcomes. This software makes the Guidelines and their application comprehensible as it maximizes allowable savings and tracks treatment and the claimant's progress.

RESULTS

What makes our bill review methodology so successful in realizing untapped savings? QRConcepts begins by not only delivering the expected fee schedule savings, but, through a detailed review of every bill - by a certified medical coder or RN - by also uncovering the hidden savings that are routinely overlooked or ignored.

Additionally, QRConcepts' tracking and monitoring of health care ensures that only treatments approved by the Fee Schedule or the NYS Medical Treatment Guidelines are approved.

The overall savings produced from containing unnecessary, excessive and/or undocumented treatment, coupled with monitoring of approved treatment, reduces lost time and results in unprecedented savings to the employer.

Finally, QRConcepts' turnaround time ensures that payments can be made in a timely manner, thereby preventing any administrative penalties that increase claim costs.

QRConcepts is based in New York. Our seasoned professional staff understands the complex challenges facing employers and carriers who handle NYS Workers' Compensation and No-Fault.