Line-by-line Inpatient Claim Review
Our hands-on Inpatient Claim Review leverages CMS clean claim principles. We perform a thorough and comprehensive review of each claim’s itemized bill to identify defects and improprieties. We employ sophisticated technology and data analytics in addition to expert clinical review by nurses, physicians, accountants, and certified coders to identify errors and compliance issues before the claim is paid. Once billing adjustments have been identified, our expert resolution team of negotiators and medical professionals work with the provider to explain our findings and come to an equitable resolution.
High dollar, inpatient claim reviews can take a few different paths and can be modified to fulfill client needs. At the core of the service is our Inpatient Forensic Review report which identifies line items and amounts to be adjusted prior to payment.