provides hospital bill reviews for insurance companies, group health companies, HMO's, OPO's, law firms, self-insured self-administered and third party administrators. This service is a useful tool during the resolution of any claim when  hospital bill charges appear excessive.

offers three Hospital Bill Review programs.  Line Item Audit, File Audit & Onsite Audit.

Reviews all codes, including HCPCS and all DME charges

Reviews Pharmaceuticals, including injectables

Reviews O.R. and Anesthesia tines

 Reviews supplies

 Hospital billing data for all 50 states

Extremely competitive pricing options available

Typical savings are significant

Databases are maintained by containing charge data from millions of medical billings from all 50 states and the District of Columbia.  This data is compared against specific claim detail provided by the client.  Medical billings are audited for all the same categories as our standard medical bill review in addition to Drugs and Supplies and DME charges.  Charges can be compared against the hospital medical records insuring that charges are credible and appropriate. 

AMBR's medical bill review process is comprehensive in scope, including:

•     UC&R Review - UC&R is an industry-generic acronym for Usual, Customary and Reasonable.  The UC&R component consists  of a national database containing data from actual provider services performed throughout the United States. It enables our clients to assess whether a provider's charge for a procedure is reasonable when compared to charges from other providers rendering the same type of service, in the same geographical region. The data is accurate to the 95^th percentile level of confidence.

•    Drug and Supply Charges - All drugs and supplies may be reviewed based on the manufacturer's wholesale price, plus a reasonable markup. Payment is disallowed for drugs that are not appropriate for the conditions being treated, based on the ICD-9.

•    Compliance   with  CPT  Guidelines  -  The  Physician's   Current  Procedural Terminology (CPT) is published annually by the American Medical Association. will ensure that provider billings adhere to the billing practices and guidelines established by the CPT.

•    Bundling/Unbundling - This audit ensures that a provider is not billing separately for several services that would normally be combined in a single procedure. This is known as unbundling. Our program will take unbundled charges and combine them to reflect the appropriate service.

•    Rarity - Our Rarity feature gives an indication of how frequently a specific procedure is performed for a specific diagnosis.  All medical services are reviewed to ensure that they are appropriate for the condition being treated. This review is based upon over twenty-five million actual provider billings from all fifty states and the District of Columbia.

•     Utilization Review - Utilization is an important part of the cost-containment formula.  This component confirms that the duration of care, and the number of visits being rendered to a patient, is appropriate for the given diagnosis.  Like Rarity, Utilization Review uses a large national database of actual provider billings.

•    Elimination of Duplicate Billing - Our system keeps a history of all billings entered on a claim and will alert the auditor when a provider charges for the same service more than once.  This feature will also detect when a provider has billed using different IRS numbers, under separate names, or if different providers are billing similar services on the same date.

In addition to the complete Line Item Audit, the File Audit consists of comparing charges in the itemized billing against the corresponding medical records that contain physician order sheets, critical care flow sheets,  anesthesia/surgery sheets, medication administration sheets, etc, to identify errors and overcharges.  This includes checking for unbundling or fragmenting charges.  The following charges are checked: