Complete evaluation of records, including organization, chronology and list of missing records.
Compilation of all medical charges that establishes reasonable value and validation of charges.
Streamlined audit and report pinpointing medical record inconsistencies in billing and chronology.
Intelligent report interpreting record content. Provides a functional road map for defense strategy.
The record review service provides a review of the medical records including identification of pertinent claim details and missing records. The report provides a case reference table, chronology of events and missing records list.
If you are solely interested in knowing what is contained within the records and are not interested in analysis or opinion, this report is for you.
Required Records: Medical Records
| Features | Record Review |
 Claim Evaluation |
|---|---|---|
| Chronological list of pertinent events |  |
|
| Pertinent missing records list | |
|
| Case overview | |
|
| Provider list without billing | ||
| Provider list with bill compilation with total vs. paid | |
|
| Provider list with medical bill audit summarizing total paid, total adjusted, total paid by patient, and balance due | ||
| Current medical treatment and prognosis | |
|
| Claim assessment (strengths and challenges) | |
|
| Medical Bill Overview | |
|
| Potential future medical care | |
|
| Future care costing | |
|
| Evaluation conclusion | |
|
| Demand evaluation | ||
| Records Required | Medical Records | Medical & Billing Records |
| Learn More | Learn More |
This medical bill audit compiles all of the medical charges by provider which are reviewed and audited by to establish a reasonable value based on diagnosis codes, standardized fee references, NCCI Edits, correct coding rules.
This audit is useful if you are looking for a compilation of charges, a transparent view of the bills and to determine if the bills are “inflated.” This audit uses scientific methodology to establish reasonable value and validation of the charges.
Required Records: All billing & statements including insurance EOB's and all medical records
| Features |  Medical Bill Audit |
MBA & Record Review |
|---|---|---|
| Organized charge data | |
|
| Billing totals | |
|
| Total reasonable value | |
|
| Review for duplication | |
|
| Review for related versus unrelated charges | |
|
| Audited using standardized fee reference methodology | |
|
| Audited using standardized fee reference methodology with application of geographic modifier | |
|
| Line item commentary to explain reductions | |
|
| Compilation of amount paid, adjusted, paid by patient, and balance due | |
|
| Review of medical record to substantiate services provided as necessary for MBA completion | |
|
| Medical records summary and chronology of pertinent events | |
|
| Evaluation conclusion | |
|
| Analysis of all providers and their charges | ||
| Records Required | All billing & statements including insurance EOB's and all medical records | All billing & statements including insurance EOB's and medical records |
| Learn More | Learn More |
This report combines the record review and med bill audit services into one streamlined report. Charges are substantiated by the record review and inconsistencies within the records are pointed out, including items related to or unrelated to the subject event. If there is over-use (ex: 3 MRI’s within a year) you would see that in the chronology of events.
Included in this report is a Provider Summary of the medical bills as well as detailed provider by provider audits summary and a chronological summary of the medical record, allowing you to look for overlapping medical care.
Required Records: All billing & statements including insurance EOB's and medical records
| Features | Medical Bill Audit |
MBA & Record Review |
|---|---|---|
| Organized charge data | |
|
| Billing totals | |
|
| Total reasonable value | |
|
| Review for duplication | |
|
| Review for related versus unrelated charges | |
|
| Audited using standardized fee reference methodology | |
|
| Audited using standardized fee reference methodology with application of geographic modifier | |
|
| Line item commentary to explain reductions | |
|
| Compilation of amount paid, adjusted, paid by patient, and balance due | |
|
| Review of medical record to substantiate services provided as necessary for MBA completion | |
|
| Medical records summary and chronology of pertinent events | |
|
| Evaluation conclusion | |
|
| Analysis of all providers and their charges | ||
| Records Required | All billing & statements including insurance EOB's and all medical records | All billing & statements including insurance EOB's and medical records |
| Learn More | Learn More |
The Claim Evaluation is an intelligent, concise and consistent report interpreting the content of the records. This comprehensive report provides a functional road map to the most productive defense strategy and a clear breakdown of the facts you need for effective negotiation, expediting settlement and reducing indemnity.
Required Records: Medical and Billing Records
| Features | Record Review |
Claim Evaluation |
|---|---|---|
| Chronological list of pertinent events | |
|
| Pertinent missing records list | |
|
| Case overview | |
|
| Provider list without billing | ||
| Provider list with bill compilation with total vs. paid | |
|
| Provider list with medical bill audit summarizing total paid, total adjusted, total paid by patient, and balance due | ||
| Current medical treatment and prognosis | |
|
| Claim assessment (strengths and challenges) | |
|
| Medical Bill Overview | |
|
| Potential future medical care | |
|
| Future care costing | |
|
| Evaluation conclusion | |
|
| Demand evaluation | ||
| Records Required | Medical Records | Medical & Billing Records |
| Learn More | Learn More |
