contingent fee-based, audit and negotiation of appropriateness of in/out patient facilities bills in...
TRANSCRIPT
Contingent Fee-Based, Audit and Negotiation of Appropriateness of In/Out Patient Facilities Bills In Lieu
of or In Addition to, a Traditional Accuracy Style Bill Review
HR Specialty Products & Services Catalogue Executive Summary
A No Frills Distillation of Vendor’s Marketing Collateral
Thomas A Ference
President & CEO
Human Resources Mining & Distribution Co
Locating, Validating and Accelerating HR Innovation
Office: 219-662-0201
Cell: 630-240-2583
Fax: 219-661-0236
e-mail: [email protected]
Website: www.hrmdco.com
Audit and Negotiation of Appropriateness of In/Out Patient
Facilities Bills
• Traditional facilities bill review services evaluate only the accuracy of the coding and not the appropriateness of the amount of the charges
• This service deploys proprietary heuristic software that reformats the data on the itemized bill to enable Medical Doctors and Compliance Specialists to identify and remove erroneous charges
• The platform works from a “Benchmarking and Proper Coding” perspective that includes the hospital’s chargemaster procedure costs, federal data and other parameters so as to also focus on what is “Fair and Reasonable” pricing for every item / service - not just the accuracy of the billed charge
Audit and Negotiation of Appropriateness of In/Out Patient
Facilities Bills
• Assigned analysts as supported by ERISA attorneys secure a post-audit signed agreement from the provider before the employer / ASO vendor is presented with the newly reduced bill amount for payment so as to virtually eliminate any balance billing, reconsiderations or possible litigation
• Covers in our out-of-network providers• Nightly EDI and encrypted transmissions of HCFA/UB/EOR data
from payer assure timely and HIPAA compliant processing • 95%+ success rate with a 32% average savings
Accuracy Type Review vs. Appropriateness Type Review
Appropriateness Review
Appropriateness Savings
Next Steps• This product/service is contained in the HR Specialty
Products & Services Catalogue™ • Operational level details about this particular service
provider can be obtained in conference with the vendor• The HR Mining &Distribution Co. is an independent and
contracted representative of the vendor• Upon your request, we will arrange for an introduction
that can range from a simple, quick conference call to a services overview / system demo
• Tom Ference 219-662-0201 (Chicagoland area) or [email protected]
• Thank you for your potential interest in this fresh thinking