Hospital Bill Review

AMBR offers two types of hospital bill reviews: Line Item Review and File Audit. Both reviews are conducted by licensed nursing staff and, like our physician bill reviews, are used to facilitate the adjudication, settlement or resolution of a medical bill or claim. Nurses review the case to ensure the claims professional has the necessary data to demonstrate that their payment decisions are based on national billing practices, industry guidelines, relevant state regulations as well as appropriate usual and customary pricing. If you are unsure which service is best for your case, one of AMBR’s licensed nursing staff will assist you in determining the most effective and beneficial service possible.

AMBR databases contain charge data from millions of medical billings from all 50 states and the District of Columbia. This data is compared against the medical bill information provided by the client. Medical bills are audited for the same categories as our standard physician bill review, but also include drugs, supplies, and DME charges.

AMBR offers hospital bill review for the following industries: First & Third Party Automobile liability, Med Pay, PIP, No-Fault, Group Health (Primary payer and Reinsurer), Government Agencies, Workers’ Compensation claims and other payers of health care services.

Line Item Review

Key Benefits

Fast turn around time

Hospital billing data for all 50 states

Easy to use defensible reports

Typical savings are 25% - 30%

Each hospital bill is reviewed for the following:

Fee Schedule Review
Drug and Supply Charges
Bundling/Unbundling
Rarity
Elimination of Duplicate Billing

File Audit

In addition to all the Key Benefits listed above for our Line Item Review the File Audit includes:

Extensive review of the medical records by licensed Registered Nursing staff
Verification that each billed item is supported by the medical records
Fastest turnaround time in the industry for this level of review
Typical savings generated by use of a file audit is 10%-25% more than just a line item review, that's a total potential savings of 35%-55%

How It Works

The claims professional submits a cover sheet along with the medical billing statements to be reviewed. Each case is handled individually by an auditing professional to assure accuracy and compliance to strict quality guidelines. When the case is approved for release, a report is generated that will explain any item on the bill that was impacted by the review process. The auditors and nursing staff are available to assist with any further clarification or information required to help finalize the claim resolution process.

AMBR can also conduct a negotiation on hospital bills where appropriate, [see Medical Bill Negotiation section]