Medical Bill Review

Archer Consultants’ program for reviewing medical bills is the process which delivers effective medical cost containment solutions for your company.  Archer combines the utilization of sophisticated software systems, expert experienced nurse reviewers, Preferred Provider Organization (PPO) Networks discounts, experienced professional negotiators, and exceptional service into a customized state-of-the-art medical bill review program.  Archer Consultants’ objective is to recommend the payment of fair and reasonable fees consistent with state regulations.

Archer Consultants will alert you if we find inappropriate service or inconsistencies in the medical treatment.  Duplicate bills and dates of service are also checked, utilizing the data base developed. All bills are reviewed by the data base and an additional “hands on” analysis is also conducted by a coder and/or Registered Nurse to determine that the computer has accurately performed the repricing and to confirm that all fees are related to the injury.  This is to insure that the process remains effective, accurate and that no “garbage in” “garbage out” computer effort has resulted.

As a medical and hospital bill payer, the payer faces the following issues:

1.         Are the DRG assignments correct and computations accurate?

2.         Was the hospitalization necessary?

3.        Is the bill reasonable?

4.        Was the treatment related to the claim?

5.        Are the ancillary services (supplies, home health care, etc.) necessary and appropriately billed?

Soaring medical expenses, hospital, physician and provider bills encompass the major areas of claims abuse to which your company has exposure. We are confident that we can also make a major contribution to reduce your present auditing expenses.

Program features include:

• DRG validation
• Extensive coding review and repricing
• Automatic state law adjustments and adherence to fee schedules
• Usual, customary, and reasonable bill review
• Hospital bill review
• Pharmacy, durable medical equipment and dental review and repricing
• Customized utilization parameters/flags
• Duplicate bill detection
• Aggressive fraud detection
• Seamless referrals to case management and negotiator professionals
• EDI capabilities
• PPO reduction
• Negotiation of fees

Results of this solution provide:

• Unparalleled success in increasing clients’ net savings
• $10.00 – $150.00 savings per $1.00 in fees