Bill review is an essential component of workers’ compensation claims management, ensuring that services reimbursed meet the directives of the care plan and providers charge an appropriate amount for those services. Every state has different fee schedules, and the rules are changing all the time. Today’s providers are focused on rendering care versus all the idiosyncrasies of each regulatory rule, modifier, billing code, and other factors. Subsequently, opportunities for errors, omissions, or just incomplete billing become prevalent.
Research from the University of Minnesota has found that between 30% and 40% of all medical bills contain an error. Current bill review solutions are focused on simple, straightforward invoices, so that outliers can easily slip through the cracks — especially if software is out of date.
Over time, these misses can cost payers thousands, if not millions of dollars.
But bill review is more than just catching common billing errors. Unanticipated charges can indicate that clinical treatment is not aligning with the plan of care or is deviating from the course of treatment initially outlined. Identifying these deviations can help course correct and keep the plan of care on track. Getting it right means better outcomes for injured workers, employers, payors and medical providers alike. The best bill review solution requires leveraging advancements in technology and the expertise of analysts to catch even the smallest of discrepancies.