Collaborative Bill Audit and Re-pricing

Sentinel MedClaims Analysts in response to client demand has added collaborative bill audit and re-pricing service for payers wishing to create a benefit structure avoiding the contradictions of PPO contracts.

By combining, On-site hospital bill audit utilizing clinicians with Cost-to-Charge analysis and direct physician contracting, Sentinel MedClaims Analysts can assist claim administrators with an ERISA compliant benefit design that allows quality coverage for their members yet avoids flagrant and excessive PPO contracts.

The California Vs Multiplan and Sutter Hospitals law suit is generally acknowledged as a long overdue acknowledgement of the relationship between hospitals and PPO networks set up to intentionally or unintentionally overcharge third party payers and their clients.

The no-audit language in PPO contracts makes them "unfair, illegal and puts all fiduciaries associated with a health plan in jeopardy of severe punitive penalties." One authority writes, "The law suit also (acknowledges) that the fees being paid for provider services are often outrageous, inaccurate, and sometimes fraudulent."

Sentinel MedClaims Analysts has expanded its physician managed bill reviews to include all facility based charges. Additionally, smaller claims are often as error plagued as their larger counterparts. Hospitals often try to make up for Medicare and Medicaid payment shortfalls by overcharging for outpatient visits. Sentinel MedClaims Analysts has expanded our audit base to include claims less than $25,000 in billed charges as an additional service to our clients."

The scale of the medical billing problem is well-known. New York State Comptroller, Thomas DiNapoli, oversaw an audit of the system in 2001 and turned up $1.8 billion in overpayments by the state of New York. The Federal Government launched the RAC audit program on behalf of Medicare in all 50 states in the fall of 2009. Let Sentinel MedClaims Analysts control your medical care costs.