Services and Products
Medical Bill Review
A line by line analysis of the medical bill using a complete itemized bill in support of the (UB-04),(CMS-1500) or other billing format. Charge challenges are identified and can be used to determine if the bill is "clean and processable" or not. Or, if the bill qualifies for a full, medical record audit (post billing).
network access and development
We have access to hundreds of networks within the US via our partners. We can provide access to you in a logo's or non-logoed network depending on your needs and the nature of the health policy or plan. If you have a network in place, we can analyze it and determine if it is optimized for your unique needs and locations. If you need a new network, we can help create it.
Medical Bill Audits
A line by line audit of the itemized bill against the supporting documents in the medical records. Usually peformed as a "desk audit" offsite but if necessary can be done on-site. Identifies all errors in coding and charges for services which appear on the billing form. May also identify potential "quality of care" issues for further investigation or independant medical review (IMR).
case management
Primarily provided for our international (non-US) and maritime clients. Local or on-site in South Florida) and telephonic around the world. Discharge planning participation, care delivery oversight, medical escort services, repatriation arrangements, participation in the care, planning and delivery process to insure effective use of medical resources and lower overall costs.
Pre and post services fee negotiation
We can negotiate a single case agreement in advance of elected medical services or put an on-going contract in place for future services. If services have been rendered or post-discharge, we can negotiate the entire episode of care and resulting medical billing(s)-which may include corrections to the medical bill resulting from our bill review, if performed.
consulting
We know health care and insurance. Tap into our years of experience in the Provider and Health Insurance industries to design, build or enhance your medical cost managment programs. Clients include every payer type within the US and abroad within the Governmental, Maritime and international insurance and reinsurance markets.