CorVel offers an industry leading medical review solution that maximizes saving opportunities for our clients. All facility bills are processed for coding, rebundling, repricing , and reasonable & customary or fee schedule review. Based on client specific thresholds or other customized specifications, bills may be flagged for professional nurse review where a team of trained, certified experts coupled with advance system review the bill against the actual medical files to remove any extraneous charges or errors – achieving fast resolution and savings. Finally, our expert fee negotiation services offer additional savings opportunities.
Enhanced Bill Review Services
Features
- Proprietary database – Universal Chargemaster
- Line item reasonable & customary adjustments
- Expert nurse review
- Compliance with Centers for Medicare Services (CMS) policies
- Utilization 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 compare to other hospitals in the same geographic area.
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 facility bills. Our team of experts reviews each line of a bill for accuracy, removal of duplicate charges, review of reasonable & 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 comparison
Professional Review
CorVel's services offer a complete audit and validation of facility bill accuracy. Our solution is unique in that it also includes review of in-network facility bills. Our staff medical nurse auditors have clinical backgrounds in all areas of medicine, medical billing and coding to ensure an accurate, consistent and thorough review.
Features
- Cost management for both in-network and out-of-network bills
- Experienced team of registered nurses from a variety of specialties
- Advanced technology ensures consistent reviews
Professional Review Savings
- Rebundling of overstated charges
- Removal of reusable equipment, standby 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 Negotiation
As an added benefit to our bill services, CorVel has a team of nurses and clinicians specially trained in fee negotiations. They have extensive backgrounds in billing and practice requirements and can negotiate bill charges to below fee schedule or reasonable & customary rates.
Services
- Correct coding policies and cost analysis
- Review to all state guidelines and requirements
- Professional review services
- Direct contact and agreements with providers
Experienced Professionals
- Nurses, clinicians, experienced professionals
- Extensive expertise in the legal, financial & healthcare industry
- In depth understanding of billing and practice requirements
- Credible professionals with experience in successful negotiations
- Strong relationships with the provider community
Features
- Data and history for "cost" vs. charges
- Negotiation expertise from experienced professionals
- Knowledge of state requirements and guidelines
Benefits
- Savings above fee schedule or reasonable & customary allowances
- Eliminate provider appeals or balance billing
- Pay only for successful savings
