Bill Review

Why Choose Cost Containment Solutions to handle your Medical Bill Auditing needs.

Our firm offers a wide range of services to our individual and business clients. Because our firm is relatively small, our clients benefit by getting personalized, and quality service that is beyond comparison. Below we have listed the implementation of services that we offer to our clients along with a brief description.

Medical Bill Review – Implementation

Our experienced staff produces significant savings with prompt pay agreements by negotiating reduced fees for hospital and physician charges on a bill-by-bill basis. We have developed quality relationships with many of the nations leading hospitals and health care facilities. Our reputation for fairness and integrity has made it possible to achieve lowest results for the industry in prompt pay fee negotiation efforts. Each negotiation results in a full release of liability so patients are assured they won’t be billed for any remaining balances. Cost Containment Solutions reviews all codes, including HCPCS and all DME charges, Pharmaceuticals, including injectables, O.R. and Anesthesia times, supplies, Hospital billing data for all 50 states.

Cost Containment Solutions utilizes databases, which are maintained and containing charge data from millions of medical billings from all 50 states and the District of Columbia. This data is compared against specific claim detail provided on the medical bill. Medical Bills are audited for Drugs, Supplies, and DME charges. Charges are compared against hospital medical records insuring charges are correct and appropriate.

Cost Containment Solutions is exceptional at reducing the costs with large, in-network or out-of-network bills. For those clients who have already committed to a PPO or bill review program, Our bill review consulting experts will work with in-network or out-of-network bills for solutions to enhance your existing cost containment programs. Cost Containment Solutions utilizes contractual relationships, and professional review negotiators, to target your most difficult medical bills. Reducing charges and providing savings with percentage of savings based fees. If we do not reduce your medical bills your invoice balance is $ 0.00.

• Cost Containment Solutions Negotiation Account Set-up for Medical Bill Review
• Locate an out of network or in network medical bill ($2,500 plus or greater)
• Complete the attached form
• Fax / Mail the form, the medical bill and the Explanation of Benefits
• Cost Containment Solutions will begin negotiation with the medical provider
• Upon successful negotiating of savings,
• Our next procedure; You receive the a invoice stating amount due to the provider
• Signed agreement and terms of the negotiated settlement
• Amount due medical provider
• Amount due to Cost Containment Solutions
• No Balance billing patients
• No Risk Savings, No Discounted Savings = No Fees
• Expedited turn around time
• Our medical bill negotiations are completed within 5 days
• Negotiations performed by professional negotiators
• Program available on a 50 state, nationwide basis
• Per bill savings ranging between 10% – 90%
• Negotiations performed on both a prospective and retrospective basis

Cost Containment Solutions Comprehensive Review:

Compliance with CPT Guidelines – The Physician’s Current Procedural Terminology (CPT) is published annually by the American Medical Association.

Our bill review specialists ensure that provider billings adhere to the billing practices and guidelines established by the CPT.

Normal / Abnormal gives an indication of how frequently a specific procedure is performed for a specific diagnosis. All medical services are reviewed for the condition being treated.

Utilization Review / Utilization is an important part of the cost-containment formula. This confirms that the duration of care, and the number of visits being rendered to a patient, is appropriate for the given diagnosis.

Duplicate Billing / Our system keeps a history of all billings entered on a claim and will alert the auditor when a provider charges for the same service. This will also detect when a provider has billed using different IRS numbers.

Drug and Supply Charges – All drugs and supplies may be reviewed based on the manufacturer’s wholesale price, plus a reasonable markup. Payment is disallowed for drugs that are not appropriate for the conditions being treated, based on the ICD-9.

UC&R Review / UC&R is an industry-generic acronym for Usual, Customary and Reasonable. The UC&R consists of a national database containing data from provider services performed in the United States. It enables our client’s medical bill reviewers to assess whether a provider’s charge for a procedure is reasonable when compared to charges from other providers rendering the same service, in a geographical region.

Bundling/Unbundling – With this procedure / audited and performed we ensure that a provider is not billing separately for several services that would normally be combined in a single procedure. This is unbundling. We will take unbundled charges and combine them to reflect the correct CPT code or service.

Cost Containment Solutions Benefits

1. Fee Schedule and UCR Review – Fee and UCR schedule are updated to assure benefits are paid accurately.
2. PPO Network Access – Cost Containment Solutions has access to National & Regional PPO networks and contracted discounts.
3. Verifies payment for medically appropriate and necessary care.
4. Flags for duplicate bills or services.
5. Code bundling/unbundling
6. Modifier reductions, multiple procedure discounts, surgical follow-up day.
7. Procedure code modifiers.

Cost Containment Solutions Medical Bill Professional Negotiations

Our Negotiation Solutions features one of the industry’s leading cost containment techniques for reducing large, out-of-network bills. Our Professional negotiators combined with databases and medical knowledge, past payment history, and experienced negotiators, implement a benchmark plan for bill reductions. Cost Containment Solutions Plus has the solution for large hospital bills reductions via hard work, contractual relationships, research, and facts allows us to provide you with an outcome that is defendable in court at no additional charges. Cost Containment Solutions services will enhance your bill review and cost containment programs with a higher R.O.I.

Benefits of Cost Containment Solutions Medical Bill Review services include:

  • Reduced expenses: medical, audit, legal, administrative.
  • Improved loss ratio and provider relationship.
  • Increase adjuster capacity and PPO retention.
  • Integration with medical bill review and PPO programs.
  • Line by Line item analysis and repricing of CPT, HCPCS , DME, DRG/Rx, and non-codable line items.
  • Cost Containment Solutions performs hospital bill repricing for each line of the itemized bill, each inpatient and outpatient stay is unique by diagnostic, demographic and procedural information is essential.
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