|
Cost
Containment Solutions Medical Bill Review Program Q&A
Our firm primarily provides National Bill Review services
for large hospital medical bills, rather they are for in-patient or out-patient services related to Workers' Compensation,
Auto, Liability or Healthcare claims for Self Insured's, Third Party Administrators, Insurance Companies and Individuals.
We provide a variety of services for individuals and self insured trust. These services include
healthcare medical bill reviews including preparation, negotiation and recovery of overpaid medical bills which we audit services
from your medical bills with providers and suppliers.
We assist with planning and forecasting for future medical
bills. We pride ourselves on our ability to provide personal service to meet your business or individual requirements in these
rapidly changing economic times.
Q. Why should I audit my claims / medical bills with Cost Containment Solutions?
A. Erroneously paid claims cause an increase
in the cost of healthcare affecting self-funded workers’ compensation, individual healthcare groups, and reinsurance
companies. Higher expenses lead to higher premiums. CCS’ audit programs may reduce healthcare expenses and may help
maintain more stable premiums.
Q. Shouldn't the TPA have performed their own internal audit process?
A. Almost all TPA's have internal audit
programs. CCS’ program differs since we look at actual medical records and itemized bills with licensed physicians and
nurses. Cost Containment Solutions compliments the current services that the TPA offers.
Q. What about confidentiality?
A. All parties to a billing audit must
comply with federal and state laws regarding confidentiality of patient information. CCS’ auditors are aware of state
and federal regulations pertaining to the use of disclosure and confidentiality of patient records. All of CCS’ auditors
conduct themselves in a professional manner, adhere to ethical standards, remain completely objective and document their findings
in its entirety.
Q: Is Cost Containment
Solutions information secure?
A:
All information transmitted by Cost Containment Solutions is in full compliance with federal and state laws regarding privacy
of medical claim data and HIPPA regulations.
Q. What
happens when Cost Containment Solutions finds an overpaid medical claim?
A. If the audit was performed retrospectively, in most cases, the provider
will agree to send a refund check directly to our client or the client can offset such amount from any future payments made
to that provider. If the audit was performed prospectively, prior to a claim being paid, the TPA will withhold the contested
amount and pay the amount not being contested.
Q. How does Cost Containment Solutions get paid?
A. Typically, all of CCS’ audits are performed
on a contingent fee basis. CCS will receive a percentage of the amount identified as an overpayment. If CCS does not save
you money, CCS does not get paid.
Optional fee arrangements can be established such as flat rates
or per bill, per line rates. Our investment in technology
and highly specialized service has resulted in some of the lowest fees in the industry. With some basic information on your
current volume and location of bills, Cost Containment Solutions will provide you with a quote.
Q. Where does Cost Containment Solutions conduct the audits?
A.
Administrators request and collect the medical records and itemized bills and forward them to Cost Containment Solutions via
EDI, Scanned OCR, Faxed, Email, Fedex, UPS, USPS, or we will provide pick up and delivery service and the bills are review
at our office.
Q.
What do you mean by bill review services that are "customized bill review program"?
A. No two companies have the same bill
audit and review needs. Partnering with Cost Containment Solutions allows you to contract for just your large hospital medical
bill review
Q.
Does Cost Containment Solutions really reduce healthcare costs by 20-60 %?
A. Yes. Twenty-plus years of combined experience, along
with very specialized knowledge of the Workers' Compensation, Liability, and Healthcare systems, enables us to reduce
your medical costs on average by about 60%.
Q. What is your average turn around time to complete a medical bill review?
A. We review and deliver bills within 3
to 5 working days. Same day processing is also available for legal or rush bills.
Q. Do you use software to perform your medical bill review?
A. Cost
Containment Solutions uses several different verities and methods, including bill review software, and manually audit line
by line items, nurse audits which capture errors and additional savings.
Q. Do you charge for duplicate bills?
A. No.
Q. Do you offer a free trial bill review
program to see if your services are right for us?
A. Yes, Contact us at 866.236.4910 or email: info@CostContainmentSolutions.com and a Cost Containment Solutions specialist will call to discuss
your needs explain the action plan for your solutions.
Cost Containment Solutions Medical Claims Audit/Recovery
Do you know if your hospital or physician medical bill
is correct?
Would you
be able to verify any errors on that bill?
What
if you were able to save and/or recover 20%-60% of your healthcare dollars?
Do you ever wonder why medical care cost so much?
The fact is that overcharges to consumers on hospital bills amount
to billions of dollars annually on a national basis.
Companies and consumers have all been a victim of hospital stay overpayments
and often times are not ever aware of it. "... 90% of roughly 31 million hospital
bills processed in the U.S. contain errors..." "Overcharges make up an estimated 66% of these errors." Money
Magazine It is
estimated that 90% of hospital bills contain errors. According to a study released by Harvard
Law School and Harvard Medical School.
CCS’ specialized team of bill auditors, physicians, and nurses audit all hospital and physician claims
above a $2500.00, on behalf of our clients. Cost Containment Solutions will review charge data on a provider bill to the medical and clinical documentation,
for correct billing codes for the charges and ensure billing is accurate.
Q. How does the Overcharge Occur?
A. An
overcharge occurs when the number of services indicated on a bill exceeds the number of services identified and documented
in the patients supporting health and clinical records. Companies need to reclaim overpaid medicals as a result of medical
billing errors. CCS works
as a compliment to individual healthcare plans, healthcare administrators, insurance companies and reinsurance companies because
we are independent auditors focusing primarily on reducing healthcare expenses by proactively reviewing claims prior to payment
and recovering overpayments.
Q. How does it work?
A.
Once a member is identified as being in a non-participating or a participating facility, the member’s information is
sent to CCS so that CCS can determine if the provider is within the CCS contracted network. Prior to discharge, CCS shall
notify the provider to submit the medical bill through the TPA to CCS or directly to CCS so that CCS can reprice the medical
bill. The bill is repriced and returned to the TPA for payment.
If the member has been discharged from the provider,
CCS will still be able to access the provider discounts. The medical bill will be forwarded to CCS for repricing and then
it will be sent to the TPA for payment.
CCS offers consulting and expertise in managed care, hospital
administration, healthcare finance, medical reimbursement, claims processing, information systems, and pharmacy administration.
Individual Medical
Bill Review
Are you unsure
if you're overpaying a medical or insurance bill?
Have you ever received an insurance company's "Explanation
of Benefits" that was full of medical codes, making it unreadable?
Have you ever had to call an insurance
company to find out why a bill was not paid?
Cost Containment Solutions Medical Bill Review services, continues
to make sure you are not overcharged, when we negotiate discounts for you.
Medical errors located by
Cost Containment Solutions consist of some of the following on Provider Bill Review, Third Party Administrators, and Individuals; Paid as primary when actually secondary Charges over the contract
limits Non-covered
plan exclusions Plan Caps Improper discounts and allowances on contract Incorrect coding and codes Duplicate charges Charges for routine supply
items such as gloves, towels, and sheets Multiple / duplicate surgical procedures Radiologists, anesthesiologists, pathologists Doctor charges Non-covered
employee/dependent
Medical Records Inspection
Companies and consumers have all been a victim of hospital stay overpayments. CCS will identify high cost
hospital claims and review medical records to ensure the appropriate billing and reimbursement was applied.
The cost of
overcharges to consumers on hospital bills amount to billions of dollars annually. Most hospitals charge patients for treatments,
services and supplies that are never actually received. This can occur because of a change in the doctor's orders or an
early discharge from the hospital. Individuals and Companies
need to reclaim amounts overpaid as a result of medical billing errors. Cost Containment Solutions' works as a compliment
to healthcare plan administrators and companies because we are independent auditors focusing primarily on reducing health
care expenses.
Contact Cost Containment Solutions for additional information at
866.236.4910
|
