Bill Review Q&A

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 over payments.

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.

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/privacy?

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. We never charge for duplicate bills.

Q. Do you offer a free trial bill review program to see if your services are right for us?

A. Yes, Contact us at 615.351.6173 or email: info@CostContainmentSolutions.com and a Cost Containment Solutions specialist will call to discuss your needs and explain the action plan for your solutions.

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