HOSPITAL BILL REVIEW SERVICES
Medical Case Management Group (MCMG) Bill Review Services determines if the
billing charges for medical care are appropriate to the workers compensation
injury/illness, and if they are in line with Usual and Customary Rates.
In addition, Medical Case Management Group will negotiate with the provider
and the facility for fee reductions. MCMG reviews provider, day surgery and hospital bills for
appropriateness of charges, identification of duplication of charges, as
well as performing detailed hospital bill audits for cost reduction. ·Review of the following types of bills: ·Review of charges according to state-mandated fee
schedules, review of charges according to Usual and Customary Rates using
the Usual, Customary and Reasonable databases ·Duplicate billing detection at the overall bill level and
at the individual line level ·Utilization parameters based on: ·Explanation of review for each bill is provided identifying
any adjustments to billed amounts, the reason/justification for the
adjustments, and the recommended payment to the provider.
Inpatient/Outpatient Hospital
Primary Care
Specialty Care
Surgery
Anesthesia
Dental
Chiropractic
Pharmacy
Physical Therapy
Durable Medical Equipment/Home Care
Ambulatory Surgical Centers
Appropriate charges for the diagnosis
Dollar Amount
CPT Code Ranges
Duration of Care
Frequency of Visits
ICD-9 Code Ranges
Provider Degrees