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Our
firm offers a wide range of services to our individual and business clients. Because our firm is relatively small, our clients
benefit by getting personalized, quality service that is beyond comparison. Below we have listed the implementation of services
that we offer to our clients along with a brief description.
Medical Bill Review - Implementation
Our experienced staff produces significant savings
with prompt pay agreements by negotiating reduced fees for hospital and physician charges on a bill-by-bill basis. We
have developed quality relationships with many of the nations leading hospitals and health care facilities. Our reputation
for fairness and integrity has made it possible to achieve lowest results for the industry in prompt pay fee negotiation efforts. Each
negotiation results in a full release of liability so patients are assured they won’t be billed for any remaining balances.
Cost Containment Solutions reviews all codes, including HCPCS and all DME charges, Pharmaceuticals, including injectables,
O.R. and Anesthesia tines, supplies, Hospital billing data for all 50 states.
Cost Containmnet Solutions utilizes databases, which are maintained, and containing
charge data from millions of medical billings from all 50 states and the District of Columbia. This data is compared
against specific claim detail provided on the medical bill. Medical Bills are audited for Drugs, Supplies, and DME charges.
Charges are compared against hospital medical records insuring charges are correct and appropriate.
Cost Containment
Solutions is exceptional at reducing the costs with large, in-network or out-of-network bills. For those clients who have
already committed to a PPO or bill review program, Our bill review consulting experts will work with in-network or out-of-network
bills for solutions to enhance your existing cost containment programs. Cost Containment Solutions utilizes contractual relationships,
and professional review negotiators, to target your most difficult medical bills. Reducing charges and providing savings with
percentage of savings based fees. If we do not reduce your medical bills your invoice balance is $ 0.00.
q
Cost Containment Solutions Negotiation Account Set-up for
Medical Bill Review q Locate an out of network or in network medical bill ($2,500 plus or greater) q Complete
the attached form q
Fax / Mail the form, the medical bill and the Explanation of Benefits q Cost
Containment Solutions will begin negotiation with the medical provider q Upon successful
negotiating of savings,
q Our next procedure; You receive the a invoice stating amount due to the provider q Signed
agreement and terms of the negotiated settlement q Amount due medical provider q Amount
due to Cost Containment Solutions q
No Balance billing patients q No Risk Savings, No Discounted Savings = No Fees q Expedited
turn around time q
Our medical bill negotiations are completed within 5 days q Negotiations
performed by professional negotiators q
Program available on a 50 state, nationwide basis q Per bill
savings ranging between 10% - 90% q Negotiations performed on both a prospective and retrospective basis
Cost Containment Solutions Comprehensive
Review:
Compliance with CPT Guidelines
- The Physician’s Current Procedural Terminology (CPT) is published annually by the American
Medical Association.
Our bill review specialists ensure that provider billings adhere to the billing practices
and guidelines established by the CPT.
Normal / Abnormal gives an indication
of how frequently a specific procedure is performed for a specific diagnosis. All medical services are reviewed for
the condition being treated.
Utilization Review / Utilization is
an important part of the cost-containment formula. This confirms that the duration of care, and the number of visits
being rendered to a patient, is appropriate for the given diagnosis.
Duplicate
Billing / Our system keeps a history of all billings entered on a claim and will alert the auditor when a provider charges
for the same service. This will also detect when a provider has billed using different IRS numbers.
Drug and Supply Charges - All drugs and supplies may be reviewed based on the manufacturer's
wholesale price, plus a reasonable markup. Payment is disallowed for drugs that are not appropriate for the conditions being
treated, based on the ICD-9.
UC&R Review / UC&R is an industry-generic
acronym for Usual, Customary and Reasonable. The UC&R consists of a national database containing data from
provider services performed in the United States. It enables our client’s medical bill reviewers to assess whether a
provider's charge for a procedure is reasonable when compared to charges from other providers rendering the same service,
in a geographical region.
Bundling/Unbundling – With this
procedure / audited and performed we ensure that a provider is not billing separately for several services that would normally
be combined in a single procedure. This is unbundling. We will take unbundled charges and combine them to reflect the correct
CPT code or service.
Cost
Containment Solutions BenefitsFee Schedule and UCR Review - Fee and UCR
schedule are updated to assure benefits are paid accurately. PPO Network Access – Cost Containment Solutions has access to National & Regional
PPO networks and contracted discounts. Verifies
payment for medically appropriate and necessary care. Flags for duplicate bills or services. Code bundling/unbundling Modifier reductions, multiple procedure discounts, surgical follow-up day.
Procedure code modifiers.
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