Self-Insured Companies & Unions

Hospital Compliance Review

Inpatient hospital bills account for the largest percentage of a self-insured company’s expense, with billed amounts often ranging from $100,000.00 to $1 million and more per visit. The margin for errors, overcharging and cost padding is staggering. Medliminal introduced the concept of “Compliance Bill Review” in 1994 when most reviews were simply performed as a medical record audit. Medical record audits only provide savings related to charges for services not ordered or performed, they DO NOT address the important issue of whether the item/service is even billable under billing regulations and guidelines. Our compliance review targets non-billable services, supplies and equipment that are already factored into the cost of other charges and/or is the cost of doing business.


The Medliminal advantage is achieved through our orchestration of the Compliance Review Process between our proprietary Robotic Process Automation (“RPA”), known as H-CAT™, and our experienced nurses and certified coders. Medliminal does not merely chase trend lines based on analytics as do our competitors, rather, Medliminal’s H-CAT™ works in perfect harmony with our trained medical staff to review each claim submitted to us line-by-line. The table below highlights the advantage of implementing Medliminal’s medical cost containment strategy by measuring the savings achieved through Medliminal’s Compliance Bill Review versus that presented by other vendors who reviewed the same claims.

Total Billed Charges Other Vendor*
Disputed Charges
Medliminal
Disputed Charges
Other Vendor
Savings
Medliminal
Savings
1 $472,302.71 $60,696.25 $122,855.50 12.85% 26.01%
2 $376,623.73 $1,287.44 $72,820.23 .3% 19.33%
3 $1,349,521.44 $250,400.00 $690,185.09 18.55% 51.14%
4 $168,644.41 $6,127.00 $22,946.50 3.63% 13.60%
5 $63,956.50 $0.00 $51,531.50 0% 80.57%
TOTAL 2,431,048.79 $318,510.69 $960,338.82 13% 40%

*Prior other vendors for each claim are not listed individually on the claim itself for confidentiality reasons. However, the vendors are large nationally recognized companies.