What’s the average bill review cost to your operations? If you’re looking for that measurable so you can understand how bill review costs affect you, good luck. While each vendor has its own idea of what bill review costs, there is no hard evidence, no independent study to say just how much this part of your claim management process should cost.
It’s a time-consuming process, and that comes at a price. So how to save money? By speeding up the process. Here are six ways to do that:
1. Establish minimum turnaround time for bill review. Make this part of your overall agreement negotiations with your bill review vendor. How many business days from receipt of the bill to return to the carrier do you expect? Also, negotiate a tracking and compliance reporting process from your bill reviewer, and require either real-time or weekly reporting.
2. Establish an electronic process to combine information. Make it easy for staff to transfer claim information and bill review results between the client claim system and the medical bill review application. By combining both claim information and bill review results into one file, adjusters can then quickly review and approve medical bill payments, plus populate their own claim system with all the data. After the adjuster vetting process, the Bill ID and approved payment amount can then be sent back to the originator, who will then issue the check and EOB. This greatly reduces data entry redundancy costs and drives faster payments.
3. Scan bills in the mail room. The less time your staff spends touching the same piece of paper, the less it will cost. Establish the process in the mail room by which all bills are indexed and scanned and shared over an Internet/Intranet platform.
4. Automate an interface between any pre-certification of treatment and medical bill review. This assures that payment for non-approved treatment is not made.
5. Automate sending different classes of medical bills to different decision pathways. For example, out of network bills with an allowed amount of greater than $10,000 go to the payment negotiation process; trauma bills automatically are routed to an RN to determine whether they are valid Trauma bills under state rules; all other business can be directed via customized routing rules to meet the carriers’ requirements.
6. Establish medical bill automatic adjudication process. For example, if the claim has been accepted as compensable, and the loss is less than 90 days old, then the rule would allow for automatic payment of bills of less than $500 from Chiropractors and Physical Therapy without requiring adjuster approval. The rule should allow for notifying the adjuster so that the claims records will reflect payment.
What time-saving processes have you put in place that have saved money?
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