Provider Bill Audits
Healthcare Recoveries’ offers a suite of provider bill audit services that validate charges billed for hospital-based treatments. This service, backed by more than 10 years of experience, offers sophisticated inpatient and outpatient hospital bill auditing based on contract provisions, compliance and DRG coding validation.
- Hospital Bill Audits: Registered Nurse Auditors work on-site to compare the medical record to the line item bill to ensure that all services performed were physician-ordered, billed supplies were actually used, billed medications were administered and that billing complies with the provider contract, including stop-loss provisions.
- DRG Validation: Medical records are reviewed by Registered Nurse Auditors to validate proper code billing and DRG assignment. Specialized DRG coding software ensures the accuracy of a principal diagnosis and inpatient claims are paid at the appropriate rates.
- Outpatient Audits: Claims Analysts perform on-site reviews of medical records, verifying bills accurately reflect the length of stay (feasible if the provider contract defines outpatient as less than 24 hours), and appropriate reimbursement rates.
- Physician Bill (MD) Audits: Certified Professional Coders review patient medical record documentation to identify providers inappropriately upcoding claims according to CMS guidelines.
- Provider Bill Review: Desk reviews performed by Certified Professional Coders compare actual billed line items to industry information to validate billed amounts and ascertain reasonability of billing amounts.