MEDICAL BILL AUDIT
Our philosophy is to reduce the enormous financial losses associated with Workers' Compensation medical claims, while simultaneously improving the delivery, quality and effectiveness of care for the injured worker. Our experience and methodology stands alone as a unique expert service available to employers and administrators today.
HERE'S HOW OUR PROCESS WORKS...
1. BILL SUBMISSION
The QRC-Exchange Portal (Quick Response Claim Exchange) makes the bill review process seamless and efficient.
We are dedicated to quickly solving time-sensitive issues involved in bill review. The QRC-Exchange Portal provides our customers with the tools they need to stay productive. Our customers can upload bills (medical reports/documents) directly to our QRC-Exchange Portal. Upon completion, the bill with its detailed EOB (Explanation of Benefits) is waiting on its company's queue to be downloaded. This secure tool is user friendly and efficient.
2. THE REVIEW
Every bill is analyzed by a medical professional specializing in NYS Workers' Compensation Law, Fee Schedules, and the Medical Treatment Guidelines. Our experts are the key to our success. They decipher medical jargon and validate the accuracy of the codes used to bill services while also ensuring that only documented services are reimbursed.
Our detailed Explanation of Benefits (EOB) reference NYS Fee Schedule and Medical Treatment Guidelines.
SPECIALTY BILL AUDIT SERVICES
Our Registered Nurse Audit Specialists are here to assist with the complexities of specialty bills:
Surgical procedures including complex two-surgeon and co-surgeon bills
Fee negotiations and repricing of Durable Medical Equipment (DME), Hearing Aids, Home Health Services and more.
APR-DRG (inpatient hospital validation pricing)
Ambulatory Surgery (PAS)
Diagnostic Testing Bills including EMG/NCV, Cardiac Clearance, Functional Capacity Testing and Complex Drug Screens
Usual & Customary Rates and BR (By Report) Rates