Medical Compliance Review
Review medical bills for billing errors prior to making payment.
Medical Compliance Review
Identify and collect on overcharges even after making payment.
Our Affiliate Law Firm
Secure clients’ plan assets by grounding findings in robust, fair legal strategy.
The Leading Edge of Medical Cost Containment
Companies and employees are both overspending on healthcare due to billing errors. Medliminal helps all payers identify and negotiate down inflated medical costs.See who we serve
THE FIVE W’S OF MEDICAL BILL OVERCHARGES
What are Medical Bill Overcharges?
A medical bill overcharge is a mistake that takes place in the billing process when a plan participant receives care, causing health plans to pay for more or completely different treatment than what actually took place.
Upcoding: the misuse and misapplication of diagnosis codes to reflect a higher intensity or level of service than actually occurred, resulting in a higher cost to the health plan.
PPO Network: stands for preferred provider organization, which is a network of medical providers contracted with the health plan that generally provide lower costs than out-of-network providers.
Out-of-Network Bills: bills plan participants receive when they have received care from out-of-network hospitals, doctors, or other providers they did not choose.
Balance Billing: also known as surprise billing, this occurs when a provider bills a plan participant for the remaining charge(s) the health plan did not cover.
Routine Services: services included by the provider in a daily service charge – sometimes referred to as the ‘room and board ‘charge.
Why, When, and Where Do Medical Bill Overcharges Occur?
Providers often use third-party billing companies that translate medical records to codes used to determine pricing. These medical billers do not speak with the providers, they simply translate the procedures in the record into codes with specific prices that reflect the treatment given. Those codes, now in the form of a bill, are then sent to the health plan. Since they never speak to the providers, misinterpretations can occur.
The next problem occurs due to the sheer quantity of codes. There are over 70,000 codes used for diagnostics and over 10,000 codes used for services rendered. This creates an easy opportunity to overcharge given the possibilities involved.
Lastly, medical billing companies often charge a percentage of the total amount charged to the patient. In other words, when they bill more, they make more.
Who Can Prevent Medical Bill Overcharges?
Through our affiliate law firm, Diceros, proprietary RPA system, H-CAT™, experienced nurses, and certified coders, Medliminal uses a pre-pay compliance review to identify errors before they are paid and a post-pay compliance review to recoup overcharges up to two years after they occur.
|Total Billed Charges||$472,302.71||$1,349,521.44||$168,644.41|
|Other Vendor Disputed Charges||$60,696.25||$250,400.00||$6,127.00|
|Medliminal Disputed Charges||$122,855.50||$690,185.09||$22,496.50|
|Other Vendor Savings||12.85%||18.55%||3.63%|