Rising’s flagship Medical Bill Review services are the foundation of our cost reduction solutions. They ensure accurate repricing, maximize savings, and allow clients to make well-informed, equitable payment decisions.

3 Key Components, Combining Technology & Professional Know-How

Rising’s Medical Bill Review program utilizes three key components: data integrity, advanced technologies, and professional expertise. Without each of these elements, Rising would not be able to deliver the return on investment (ROI) clients have come to expect from us:

  • $8 to $78 return per $1 in fees
  • Additional return of $3 to $4 per $1 in fees when enhanced with our Specialty Bill Review

Data integrity is the first crucial step in our bill review process. We ensure data accuracy through redundancy, automated scrubbing, dynamic logic, and manual intervention as appropriate.

Rising’s technology backbone combines millions of lines of code, advanced software architecture, multiple data sources, sophisticated information management techniques, artificial intelligence tools, and complex automation into a powerful system that helps maximize savings.

Most important to Rising’s process is our people. While our technology provides operational efficiencies and speed by automating standard rules, our auditors look at the nuances of medical bills and records to bring clients enhanced financial outcomes. Capitalizing on the expertise of our people allows Rising to produce quality in our bill review process, not just quantity.

Bill Review Program Offerings Include:

    • Extensive coding review and repricing
    • Automatic fee schedule and state law adjustments
    • Usual, customary and reasonable review
    • Contractual provider discount application
    • Customizable utilization review parameters/flags
    • Robust duplicate bill detection: 99.9% accuracy vs. 85% industry average
    • Aggressive fraud detection
    • Seamless referrals to our Specialty Bill Review unit
    • Client Web Portal for bill approval and reports access
    • Submission of state and NCCI reporting
    • Provider Payment solutions
    • Seamless program implementation that we like to call Simplementation®

“We look at the oddities that even sophisticated systems can’t pick up. We do an in-depth analysis on the medical bills rather than depend solely on technology.”

– Mary-Beth, VP of Medical Bill Review Operations


Medical Bill Review Services: