The HealthCare Industry Back Offfice

Insurance Bill Review

RapidCare Insurance Review Services:
Our Bill Review experts leverage process and technology best practices to assist clients reduce non-compliant expenses; streamline and reduce bill review cycle times while giving an increased ability to achieve early discounts. The RCS team offer a full outsourced solution to help the client appropriate tasks to unbundle and utilize a delivery model that make the best use of all available resources to achieve your goals. Services are delivered effectively on assigned work offering jumpstart expertise, experience, and efficiency to maximize the value of your outsource cost.

Improve Efficiency, Quality and Outcomes:
Our valuable bill review services ensure accuracy in claim associated costs, mitigate surprises, and our reviewers are ready to tailor the review that’s likely to be the cornerstone of your risk management program. Team can operate on your Information System and adapt to your workflow.

The RCS team crosses a broad range of Bill Review services to apply on all types of claims including in-network and out-of-network claims. Every line is reviewed 100% for all lines of coverage by expert humans and team’s work product is provided within the parameters established to conduct Bill Review on all medical bills received.

Reliable and accurate Bill Review functions including:

  • Reviewing, auditing, and repricing all medical bills approved by the Claims Adjuster
  • Examine how accurately medical charges are coded on medical bills and the propriety according to accepted standards and guidelines
  • Conduct current State Fee Schedule, In-Provider Network Fee Schedule, Out-of-Network Fee Schedule, and Usual & Customary assessment
  • Ability to provide audits on bills with triggers established by the Carrier
  • Give status on bills being processed by the Medical Bill Review team, i.e., not received, being re-priced, sent to Risk Management for payment
  • The performance/service standard assures that all medical bills are processed timely and in accordance with the rules and guidelines
  • Review of Billed Charge
  • Apply usual-and-customary rates for incurred services
  • Review procedures to determine appropriate level of service and CPT code
  • Identify duplicate charges
  • Review bill based on fee schedule limits on designated procedures
  • Application of Discount