The healthcare industry is fraught with various kinds of errors - billing, coding & the resultant payment errors. These reasons maybe due to human error, paper work errors, system errors or errors arising out of lack of complete information, all of which need to be identified & corrected to ensure appropriate claim payment. Patients are sometimes billed for the services, medications, and supplies that they never received; hospital rooms and equipments that they never used; & for the same service more than once. Most of the times the charges entered by an individual within the hospital do not correlate with the exact date of usage. The Hospital Bill Audit helps to control the errors and erroneous charges in the billing systems.

How can Data Marshall Help?

Data Marshall provides the services to validate proper payment of Hospital Bills for payers. A meticulous review & comparison of the service/line level of the itemized statement/bill to the corresponding medical records is performed, to verify that all items and services which were prescribed and billed are appropriate. The analysis team conducts an initial documentation review to identify potential discrepancies. Physician orders, patient medical records, reimbursement contracts, hospital charge masters, and itemized bills are reviewed to validate coding and billing accuracy. Discrepancies are documented and reviewed.

Our overall assessment leads us to the conclusion of a settlement which is fair and equitable for a provider to have charged, and which is conversely, fair and reasonable for a payer to expect to pay for the services rendered.

Benefits

• Recovery of revenue from inaccurately paid claims
• Increase in revenues & profitability
• Analysis of the Billing/Coding practices & patterns

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