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?
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.
Q. Do you offer a free trial bill review program to see if your services are right for us?
A. Yes, Contact us at 866.236.4910 or email: info@CostContainmentSolutions.com
and a Cost Containment Solutions specialist will call to discuss your needs explain the action plan for your solutions.
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
overpayments.
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.
Individual Medical Bill Review
Are
you unsure if you're overpaying a medical or insurance bill?
Have
you ever received an insurance company's "Explanation of Benefits" that was full of medical codes, making it unreadable?
Have you ever had to call an insurance company to find out why a bill was not paid?
Cost Containment Solutions Medical Bill Review services, continues to make sure
you are not overcharged, when we negotiate discounts for you.
Medical
errors located by Cost Containment Solutions consist of some of the following on Provider Bill Review, Third Party Administrators,
and Individuals;
Paid as primary when actually secondary
Charges over the contract limits
Non-covered plan exclusions
Plan Caps
Improper discounts and allowances
on contract
Incorrect coding and codes
Duplicate charges
Charges for routine supply items such as gloves,
towels, and sheets
Multiple / duplicate surgical procedures
Radiologists, anesthesiologists, pathologists
Doctor
charges
Non-covered employee/dependent
Medical
Records Inspection
Companies and consumers have all
been a victim of hospital stay overpayments. CCS will identify high cost hospital claims and review medical records to ensure
the appropriate billing and reimbursement was applied.
The
cost of overcharges to consumers on hospital bills amount to billions of dollars annually. Most hospitals charge patients
for treatments, services and supplies that are never actually received. This can occur because of a change in the doctor's
orders or an early discharge from the hospital. Individuals and Companies need to reclaim amounts overpaid as a result of
medical billing errors. Cost Containment Solutions' works as a compliment to healthcare plan administrators and companies
because we are independent auditors focusing primarily on reducing health care expenses.
