We help Self-Insured Groups, Employers, and Unions cut healthcare costs without sacrificing quality.

Stop Medical Cost Hemorrhage!

medical bill consultants

Self-funded corporate healthcare expenses are so erroneous that companies are frantically searching for ways to stop financial bleeding. Medical Bill Advocacy may be the solution to your problem of dealing with the frivolous medical charges.

Is your company considering:

  • Dropping Retiree Benefits?
  • Increasing Employee Premium Share?
  • Decreasing Benefit Coverage?
  • Claiming Bankruptcy?
  • Closing the Business?
Call Today For Your Free Consultation (855) 203-7058

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Our Comprehensive Hospital Compliance Audits Include:

A simple tourniquet may reduce your annual payout by

8% to 12% or more.

medical billing advocate

How often does your TPA get you refunds from providers and/or credits from benefit overpayments? Due to the complexity of the medical billing system and guidelines, it would be impossible for TPAs to scrutinize every claim your company receives. MRS analyzes your claims payout in areas your TPA couldn’t possibly have the time, staff, and/or program edits to accomplish, and typically finds overcharges–and overpayments–of six and seven figures for a single plan year.

Our proprietary auditing methodology, composed of our exclusive Provider/TPA claims investigative software accompanied with our manual review, scrutinizes every line of paid claims, with a focus on provider overcharges and TPA overpayments. Identified errors are brought to the TPA’s attention for confirmation. Upon review of the TPA’s response, a receovery process is implemented for your company.

Our Comprehensive TPA/Provider Audits Include:


1. Compliance

Determine compliance with both the contract terms and plan provisions


2. Accuracy

Evaluate accuracy of provider billings and highlight TPA overpayments


3. Assessment

Assess for potentially abusive or fraudulent claims per provider profiling


4. Recovery

We also assist in the recovery of overpayments from providers and TPAs

med bill

Virtually all of our corporate clients have received the unexpected and immediate bonus of an “instant” quarterly payout reduction (compared with previous quarters) subsequent to MRS audit report that identified areas of waste and abuse. .

In addition, MRS can also consult with you on a variety of other cost savings methods, including employee cost awareness programs, TPA service agreements that protect corporate’s financial dollars, and benefit plans that retain great benefits but eliminate waste and abuse.

 

Most of these errors result in money being owed to your company and/or your employees.

Is your TPA catching these errors?

Call Today For Your Free Consultation (855) 203-7058

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Comprehensive TPA/Provider Audit:

hospital bill negotiation

Under the laws of ERISA, any self-funded company is responsible for monitoring its own healthcare plan. You and your board of directors are obligated to ensure excellent TPA performance according to the terms and conditions of the benefit plan. MRS can help you achieve these goals.

MRS’ normal protocol for auditing for self-insured clients includes determining if the providers are billing properly and in accordance with state, federal, and local laws. Equally important is the third party administrator’s adjudication of claims in accordance with the benefit plan developed by the corporation.

Our comprehensive audit services provide a thorough investigation into more than 70 areas of concern, including:

  • Payments to anesthesiologists for services actually performed by CRNAs
  • Miscoding of surgical procedures to gain full rather than a reduced payment
  • Duplicating reimbursement by misapplication of procedure codes
  • Improperly calculated professional/technical components of lab and radiology services
  • Assessment of potentially abusive or fraudulent claims, per provider profiling, by evaluating subscriber claim history and employing other analytical techniques.

In addition to the core analytic work described above, MRS’ data mining tools include the following staff analysis:

  • When necessary, hard copy claim documentation reviews to verify product/service delivery and to reveal up-coding
  • Relational database analysis of group healthcare expenses using MRS-designed software
  • TPA claims and surveillance to screen for areas of potential overcharges and flag suspect areas deserving comprehensive review by an analytic team
Click here to see how our detailed audits have paid off for our clients

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representative will be in touch to discuss your needs.


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hospital bill audit

Very little time and effort is required from you and your TPA to provide the information required for us to perform our audit:
Information required from Self-Insured Company:

  • Copies of the service agreement(s)/amendment(s) between company, TPA, and re-insurance company
  • Copies of the Summary Plan Description
  • Participating Provider Booklets
  • Disk containing data on eligible employees and dependents, to include names, DOB, effective and termination dates and coverage type
Audit data required from TPA: Disk in Access format, with claim transactions that occurred during the period selected for audit. Fields will be specified in letter to TPA.