CorVel's enhanced bill review services offer a complete medical saving solution for all of your in-network and out-of-network medical bills. Each feature of utilization services focuses on maximizing your savings opportunities and increasing efficiencies. Our services define and adjust line item charges on all medical bills to reasonable and customary levels as provided under most insurance programs.
Enhanced Bill Review Services
Features
- Proprietary database – Universal Chargemaster
- State-by-state and client-driven rules engine
- Financial repricing to appropriate, defensible payments
- Expert surgical nurse review
The Universal Chargemaster is a compilation of individual chargemaster line item descriptions from over 90% of the nation's hospitals. It is a virtual thesaurus of hospital billing terms, codes and abbreviations. Unique line item descriptions are evaluated by the Universal Chargemaster and appropriately compared to other hospitals in the same geographic area.
Benefits
- Average savings of up to 40% per bill
- Legal and regulatory support
- Supports ERISA fiduciary responsibilities
- Percentage of savings fee structure
Line Item Bill Review Services
As part of our enhanced bill review services, CorVel offers line item bill review for in-network and out-of-network medical bills. Our team of experts reviews each line of a bill for accuracy, removal of duplicate charges, review of reasonable and customary charges for the local area, fee rebundling and any other opportunities to ensure maximum savings.
Services
- Capture original charge data
- Reasonable and customary review by zip code
- Fee rebundling and error removal
- Separation of charges by diagnosis
- Facility to facility cost comparisons
Professional Review
Using CorVel's enhanced bill review system and Universal Chargemaster database, our professional review provides a complete audit and validation of medical bills. CorVel's staff of experienced surgical nurse reviewers and Certified Professional Coders (CPC) have backgrounds in all areas of medicine as well as medical billing and coding to ensure an accurate, consistent and thorough reviews.
Features
- Cost management for both in-network and out-of-network bills
- Experienced team of surgical nurses and CPCs
- Advanced technology ensures consistent reviews
Professional Review Savings
- Rebundling of overstated charges
- Removal of reusable equipment, stand-by and set-up fees
- Removal of charges for unused supplies, duplicates and errors
- Validation and correction of time increment charges
- Identify and adjust quantity discrepancies
Expert Fee Negotiations
As an added benefit to our bill review services, CorVel offers a team of senior negotiators and clinicians specially trained in fee negotiations. They have extensive backgrounds in billing and practice requirements and can negotiate medical charges below charges, applicable fee schedule, and/or reasonable and customary rates.
Services
- Professional review services
- Correct coding and perform cost analysis
- Signed agreements for negotiated amount
Experienced Professionals
- Nurses, clinicians, experienced professionals
- Expertise in the legal, financial and healthcare industry
- Credible professionals with experience in successful negotiations
- Strong relationships with the provider community
Features
- Data and history for cost vs. charges
- Reasonable and flexible turnaround times
- Knowledge of state requirements and guidelines
Benefits
- Savings above fee schedule or reasonable & customary allowances
- Reduce provider appeals or balance billing potential
- Percentage of savings fee structure
Implant Reimbursement
A challenging cost containment issue is pricing implantable devices. A majority of implant items are not purchased/stored by hospitals and are commonly referred to as "pass-though" charges, with an average of a 400% – 500% mark up. Because not all states have a carve-out for implants, payors are responsible for adjusting to fair and reasonable rates. Additionally any adjustments to implant fees require attainment of the hospital's invoice, causing further delays in final claim adjudication.
To assist customers with these implant reimbursement challenges, CorVel developed a proprietary database comprised of actual implant invoices from throughout the country. This database provides payors with a multilayered approach to determine a reasonable reimbursement with average savings of up to 67% per implant.
Services
- Average cost determination of implants
- Professional review by registered nurses
- Reasonable and customary statistics of actual provider charges
Features
- Stand alone service for implant payment determination
- Payment processing with no waiting for hospital records
Benefits
- Overall savings of 67% from billed charge
- 35% increase in savings over reasonable and customary
- Decrease loss ratio and medical expenses
- Payments paid without 'pend/hold'
