Rising’s Workers’ Compensation Medical Bill Review services form the foundation for our cost reduction solutions, ensure accurate reimbursement, maximized savings, enhanced outcomes, and enable clients to make well-informed, appropriate payment decisions regarding their medical expenses.
The Synergy of Technology and Professional Know-How
Data integrity, software architecture, system automation, and bill review/clinical expertise are the cornerstones of Rising’s Medical Bill Review program. Without each of these four components working in concert, Rising would not be unable to deliver the Return on Investment (ROI) they expect from our bill review services:
- $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, so data accuracy is ensured through redundancy, automated scrubbing, dynamic logic and manual intervention as appropriate.
The sophisticated technologies of our software architecture, with millions of lines of codes, multiple data sources, and advanced artificial intelligence tools, combined with the advanced automation we bring to the bill review process, pack a powerful one-two punch to further maximize savings.
But most important to our process are the people. The expertise of our bill audit and clinical staff are unrivaled in the industry, as is their attention to the nuances of each bill and medical records. Trained to identify those issues or errors that even the most sophisticated of systems cannot find, they deliver enhanced outcomes to clients that focus not merely on quantity, but on the quality of the bill review process.
Key components of the Workers’ Compensation Bill Review Program 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™
“The market sometimes thinks of bill review as a commodity. The type of passion and expertise that Rising brings to big bill audits simply can’t be duplicated.”