Covenant Specialty
Medical Bill Review
Covenant Specialty offers specialized medical bill review and analytical services designed to significantly reduce medical claim costs.
Covenant Specialty deploys proprietary medical bill verification tools that provide prudent, defined, replicable, verifiable, defensible and standardized methodologies for evaluating medical claims for potential provider billing errors and inaccuracies.
Medical bill verification tools use procedures and processes that rely upon nationally recognized and defensible resources to evaluate the medical bill for potential billing errors and inaccuracies.
Review of hospital inpatient, outpatient and outpatient surgery center services include line-by-line repricing of itemized bills and audits of medical records. Medical records reviews are conducted to identify cost reduction attributable to:
- Hospitalization Medical Necessity
- Level of Care
- Length of Stay
- Experimental/Investigational procedures
- Quality of Care Review
Operative reports are reviewed to determine proper CPT coding with primary/secondary/tertiary procedure identification and repriced accordingly.
Bill analytics and repricing services are also provided for Emergency Room, Dialysis, Chemotherapy, Air/Ground Ambulance, and Prosthetics/Orthotics/Implants.
Proprietary databases and sophisticated rules engine are maintained by Covenant Specialty and contain charge data from millions of medical billings. The medical bill verification tools expose and identify:
- Billing errors such as
- Excessive billing
- Incorrect or inappropriately billed charges
- Unexplained, incomplete or undocumented charges
- Duplication detection for billing of like items
- Improperly billed medications
- Incorrect coding
- Unbundling of services and supplies to verify the accuracy of the bills
- Usual Customary and Reasonable charge analysis and repricing per geographic region
Fee Negotiation Service
The Covenant Specialty's experienced staff produces significant savings through direct negotiation with facilities for reduced fees. Covenant Specialty's services help clients avoid paying unreasonable charges. Claims are evaluated for errors, upcoding, unbundling, overcharges, and comparison with Usual Customary and Reasonable charge databases. Providers are contacted to discuss any billing, coding or pricing issues.
Fee Negotiation results in a full release of liability. Patients are not balance billed for remaining balances. Covenant Specialty obtains a signed agreement from the provider on all negotiated discounts.
