In essence, the medical bill review process is a “tool” used to facilitate the adjudication, settlement or resolution of a medical bill or claim.  Our pricing and fees are very competitive and tailored to meet the needs of our clients.  

ü  24-hour turn around

ü Excellent reports and explanations of review

ü Management reports including Return-on-Investment

ü  Can accept bills via email, fax, mail, Electronic Data Interchange (EDI)

ü Available for all 50 states

üCompliant with all State fee schedules

Medical bill review for First & Third Party, Med Pay, PIP, No-Fault, Group Health and Workers’ Compensation claims include the following audits: (Click on heading for explanation)

Fee Schedule Review   

UC&R Review

Drug & Supply Charges

Rarity

Utilization Review

Compliance with CPT Guidelines

Bundling/Unbundling

Elimination of Duplicate Billing

Fee Schedule Review – Ensuring that billings are compliant with the most current state-mandated fee schedules, administrative rules and regulations. top

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. top

Drug and Supply Charges – All drugs and supplies may be reviewed based on the manufacture’s wholesale price, plus a reasonable markup. top

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. top

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. top

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

Bundling/Unbundling – This audit ensures that a provider is not billing separately for several services that would normally be combined in a single procedure. top

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. top   

If you would like to have a bill reviewed, click here for our Cover Sheet.  Fill out the form and attach it to the bills you would like reviewed.  Requests can be submitted in the following manner:

Please Note:  You must have Adobe Acrobat Reader to open form.  You can download it for free here:

By Mail: AMBR, P.O. Box 492710, Redding, CA 96049

By Fax:  530.224.3390

By E-mail:  Claims@ambr.com

© 1998 American Medical Bill Review, Inc. All rights reserved.