Pre-Billing Audits

Medical Review Service

• Make sure all charges are correct before the bill goes out the door
• Especially important on accounts that are close to the stoploss amount

Most accounts are paid by DRG these days, but many contracts still have stop-loss dollar amounts where cases change to a percent of charge payment.  How frustrating is it when an insurance company later reviews that case, and the amount drops below the stoploss amount and ends up throwing off your budgeted amount?  An audit of these cases can give you confidence that you’ll be getting the payment you’re entitled to. 

On the other hand, what if some charges are missing on that account that is just below the dollar threshold?  You could be leaving money on the table.  A good rule of thumb is to audit accounts within a few percentage points of the stop loss amount to make sure these accounts are charged appropriately.  Even finding one account that reaches the stop loss, can pay for the cost of working these accounts regularly.