Services The MRS Advantage

Our success depends on your success. That is why Medical Review Service designs comprehensive audit programs that are as unique as our clients.

Our services include Concurrent Chart Audit Programs, Insurance Defense Audits, Patient Request Audits, Pre-Billing Audits, Focus Audits, Compliance Reviews, and special projects.

Concurrent Chart Audit Program

Medical Review Service provides our clients with monthly audits of recent accounts, both inpatient and outpatient. Our team compiles reports of audit discrepancies by hospital departments and presents the audit results to department directors at monthly chart audit meetings. Not only do we identify possible causes for the errors found, our experience with multiple hospitals allows us to suggest potential solutions and fresh strategies for improvement. In addition, we regularly follow up with department directors to ensure that the implementation of corrective actions has occurred. By working closely with management, we are able to minimize billing and documentation errors and maximize compliance and reimbursement for our clients.

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Insurance Defense Audits

For more than 25 years, Medical Review Service has represented its clients by defending their charges to external insurance auditors. Prior to meeting with the insurance auditors, MRS audits all accounts in their entirety. We work with your business office, medical records department, and ancillary directors to confirm that documentation is accurate and appropriately placed in the medical record. As a result, we capture unbilled items and recover lost revenue for our clients.

Our vast experience with external auditors has trained us to anticipate their audit issues and fully prepare to defend hospital charges successfully. At the conclusion of each audit, we present a full report of audit results to our client.

The insurance companies have auditors dedicated to serving their priorities. Who will you have serving yours?

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Patient Request Audits

Independent audit firms can best perform audits requested by a patient. Patients more readily accept audit findings because the review is completed by an entity not affiliated with the hospital.

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Pre-billing Audits

MRS can perform pre-billing audits for managed care accounts. Accounts close to the stop loss amount set by the managed care contract are audited prior to billing for two purposes. It allows the hospital to send out a clean bill to insurance carriers, thus discouraging future defense audits. In addition, if net undercharges bring the account total above the stop loss amount, reimbursement is dramatically increased, optimizing reimbursement from carriers.

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Focus Audits

When a billing problem has been identified, focus audits take an in-depth look at the issue. Through these audits, we are able to pinpoint the root cause of documentation and billing errors so that corrective actions may be taken. Follow-up focus audits may be completed to assess the effectiveness of the corrective action.

We have conducted focus audits involving emergency room charges, specific nursing units, implant charges, controlled substances, respiratory treatments and observation charges. Focus audits can be tailored to your specific needs.

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Compliance Reviews

Governmental compliance is essential in today's healthcare environment. Medical Review Service's experience makes us a valuable resource for assuring our clients' compliance with governmental regulations including CMS, AHCA, and Sarbanes Oxley.

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Special Projects

To meet the diverse needs of our clients, Medical Review Service also can perform special projects. Projects include chart audit process reviews, KePro reviews, billing system process reviews and nursing documentation education, among others. Projects can be tailored to meet your specific needs.

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