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The Problem with Overbilling

With many examples of fraudulent charges coming from nationwide sources it is clear there needs to be a focused effort to battle unnecessary billing services for the sake of businesses and their health expenses. This is vital in the workers compensation arena as employers strive to provide quality care for injured workers.
With this in mind, our bill review analysts are on the lookout for overbilling in the following areas:

Unnecessary Treatment Billing:

One of the most common areas of overbilling is unnecessary treatment.  When reviewing medical bills for payment it is important to note what the compensable injury is.  Does the diagnosis and treatment being provided correspond with the patient’s workers comp injury? Unnecessary and/or unrelated treatment can be administered and billed if time is not taken to thoroughly review bills submitted for payment on a work comp injury.  Many of the unnecessary charges come in the form of medical tests or services unrelated to the injury being treated.  An example would be an employee who sustains a knee injury on the job site being treated for neck or hand injuries. Our analysts are trained to ensure that treatment being billed is for the compensable injury and nothing else.

Services Provided

Did the provider actually perform the services he or she has billed for? Unlike unnecessary treatment, unnecessary services are services a doctor does not perform yet submits a bill for.  This can often be the case with surgeries, and tests that were billed for, but were never administered.  Our trained professionals can spot and address these overbilled services, minimizing claims cost.

Over Utilization of Treatment

Nurse case management and bill review services work together to ensure that employees get the appropriate treatment to recover from their injury and return to work in a timely manner. Overbilling can occur if too much care is given for the level of treatment.  Examples of this could be extended hospital stay for a minor procedure or more physical therapy than needed. These are ways of overbilling and if unnoticed lead to substantially higher workers compensation costs and time off work for your employees. 
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