Medical Bill Review and Auditing

ACCURATE’s Bill Review and Audit Service helps clients reduce costly billing errors and allows them to take control of costs by revealing duplicate charges, incorrectly calculated charges, and charges for services never rendered.

Through our pre-payment audit process, we identify auditable claims and then verify that billed services were ordered by the physician, rendered to the patient, and charged at appropriate rates. Oversight claims management can also be provided to assist with setting case reserves based on known medical conditions or diagnoses.

ACCURATE combines advanced technology with knowledgeable and experienced audit staff to maximize savings for clients. This approach consistently delivers higher savings than other bill review methodologies, as it utilizes the experience of highly trained examiners, coding specialists who apply their expertise and judgment to medical bills and an on-site Medical Director to review treatment protocols.

Bill Review and Audit Services provided, include:

  • Prospective Audits – Auditing of all large hospital and questionable physician bills prior to payment.
  • Retrospective Audits, including :
    • Hospital Bill Audits – Review large hospital bills for overpayment, induced demand, and other erroneous charges.
    • Physician Bill Audits – Review physician bills for overpayment, induced demand, and other erroneous charges.
    • Medical Record Audits – an auditing tool often used to ensure that the medical records meet the documentation standards required to validate charges.