subject: Professional Medical Claims Review Services For Insurance Companies [print this page] Insurance companies lose thousands of dollars every year from health care fraud cases. To curb the rising number of misrepresentations and ensure that claims are legitimate, insurers conduct reviews of medical claims. The professional medical claims review services that outsourcing companies in the United States offer insurance companies helps them ensure accuracy in the medical billing process.
Medical Claims Review to Solve Various Issues
The claims review process involves evaluating individual claims for fraud or errors, which can include performing services or procedures that are medically unnecessary, misrepresenting treatments that are not actually covered as medically necessary, giving false diagnosis to defend tests or surgeries performed, and so on. Competent and unbiased medical claim review can help unravel the truth and minimize the payment of illegitimate claims. Professional medical record review companies offer support for claim review and can
Assure that claims are paid in relation to health insurance plan benefits
Discover administrative and coding errors resulting in disparity between diagnosis and procedure/treatment
Identify errors in payment
Established medical claim review companies help medico-legal professionals appointed by insurance companies by collecting evidence to prove/disprove a claim, organizing pre-trial documentation, and conducting medical chart audits. They can conduct utilization reviews which involve reviewing requests for medical treatment. This helps confirm the appropriateness of the recommended treatment and check whether that the plan covers the medical services provided.
Their medical review services involve capture of demographic characteristics, medical treatment including ambulance services and ER department details, diagnostic procedures, therapy notes, and so on. If the case is one of a social security disability claim, they provide proof about the current disability and also as to when the disability began.
The data is organized, summarized and tabulated in a comprehensible format, with chronologies and timelines. The reviewed records can then be easily compared against billing information to determine the accuracy of the claims.
Competent Claims Review Services at Affordable Cost
A medical record review company that has sufficient experience in the field can offer professional medical claims review services for insurance firms at affordable cost. Other benefits that follow from partnering with the right service provider include:
A dedicated team of experienced professionals on each project
Stringent QA to rule out errors
Multilevel audit trail
Timely reports
HIPAA compliance
Solutions on client-preferred technology
Custom services in required turnaround time
Besides medical claim review, well-known medical record review firms offer support services for medical peer review, medical chart review, and medical legal review.
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