Selecting the Best Solution
StrataCare provides its clients with the best of both worlds in bill review... software solutions or outsourcing services. Why would someone select outsourcing instead of performing the challenging process of bill review themselves?
The answer is simple... Cost Effectiveness!
The answer is also complex. Bill review is not just a basic process of adjudicating medical bills based on state fee schedules, UCR databases, and applying PPO discounts. This approximate 70% portion of bill review is the easy part. The difficult part is the remaining 30% of complex bills such as high level, technical, medical legal, surgery and hospital bills and bills by report or where Relative Value Not Established (RNE) exists.
Software Limitations
There is no software product or system that can automatically re-price these types of highly complex bills. The fact is a client should not want these types of bills to be processed automatically! What good is automation and saving some time when the result is a loss of significant net savings?
These types of bills require a skilled high-level bill review technician's ability to read, interpret, compare and correlate relative value to obtain the maximum savings at the lowest fee possible. Skilled high-level review is not something that a basic bill review technician can provide.
Reading and interpreting surgery reports and other complex bill supporting documents require time and expertise. Both of which dramatically increase the expense of doing bill review internally. This necessary expertise and its related cost are often overlooked when organizations consider performing their own bill review.
Unless the organization has sufficient bill review volume to absorb the additional fixed cost of a high-level review staff then it is most likely more cost effective to outsource all bill review or at least their high-level bills.
CareSolutions®… The Best Choice for Outsourcing
CareSolutions Bill Review Service Center can provide a total outsourcing solution for clients who cannot fully cost justify doing their own bill review internally. We're also able to support clients' bill review practices through supplementing just their high-level bills.
CareSolutions high level specialty review staff offer a cutting edge service that delivers industry-leading results. Our skilled technicians have an average of seven years experience and always obtain the absolute maximum savings allowable by law... at a fee that is in our client's best interest.
Whether its software, outsource services or a combination of both... let StrataCare show you how to build a truly cost effective bill review solution.
