Hospital Bill Auditing

United Review Services has 20 years of hospital bill auditing experience in auto, workers compensation and health claims, both with carriers and self-insurers.

Our program is unique in its focus on the clinical review of hospital bills, incorporating the experience of our dedicated Auditing R.N.s who review, in addition to the itemized bill, the entire hospital chart, consultations, all relevant claim information, accident reports and other information to identify inappropriate or non-related charges, duplicate or undocumented charges, inappropriate DRG assignment (if applicable), and other irregularities.

For DRG bills, we determine whether the most appropriate DRG has been assigned by the hospital or if a less expensive and more appropriate DRG may be applicable. We also check the DRG billing calculations to make sure that the hospital has utilized the applicable rate period to result in the correct amount due.

To contain auditing costs, we provide free prescreening within 48 hours of all referred hospital bills to determine savings potential. Our field auditing staff can perform on-site hospital audits in all locations, and our in-house staff handles desk audits upon receipt of the appropriate medical documentation. Detailed reports show audit activities, reductions, and rationale on each case, and periodic management reports track overall results for each customer.

To prevent balance billing or disputes with the client or insured, we also finalize each audit with the hospital after reaching full agreement on the medical or billing issues applicable to the bill, as well as the amount to be paid. Additional discounts are often negotiated on behalf of the carrier.

Our auditing services average a return of over $10.00 in bill reductions for every $1.00 spent by clients.