StrataCare offers the next level of bill review analysis with the Nurse Audit Review program to validate facility and surgery billing accuracy. Our professional nurse review team will verify each line item against corresponding medical records to ensure appropriateness of charges and maximize bill review savings. This intensive audit will check for accuracy, diagnosis and treatment consistency, unbundling of services, coding errors, and time and quantity matching.
Due to the complexity and dollar size of certain types of medical bills, adding a nurse’s skilled interpretation and hands-on evaluation can uncover inappropriate charges and services. Our electronic bill review system is accurate and offers many automated functions to review bills for savings. However, through the professional interpretation, analysis, and scrutiny of the nurse audit team, there is potential to further identify errors and inappropriate coding. This service applies to both in-network and out-of-network bills processed by CareSolutions.
The Nurse Audit Review evaluates service lines for:
- Billing Accuracy – Facility and surgery bill validation
- Diagnostic Related Group Validation – Facility bills reviewed for DRG
- Rebundling – Inappropriately unbundled or upcoded services
- Diagnosis Matching – Services performed match injury or diagnosis
- Coding Errors – Disallowance of incorrectly billed charges
- Quantity and Time – Increments fit treatments rendered
- Reusable – Disallowance of reusable equipment, supplies, standby, and associated set-up fees
- Pharmacy – Medically supported and correct dosage
The Nurse Audit Review is applied to bills as determined by the thresholds set by the dollar volume or bill type and complexity. This program will lower medical expenses by 10 to 15 percent below fee schedule and UCR for these bills. StrataCare stands 100% behind our reviews, and litigation support is also included at no additional cost.
Our qualified nurses are trained in Workers' Compensation laws and have many years of experience with billing and coding laws to ensure that providers are billing for the services that are appropriate and that the services billed were actually performed.
The Nurse Audit Review service is a valuable cost containment tool and is an added savings opportunity for our clients.
