Best practices in bill review
"Leveraging analytics to strategically define the access order for national and regional provider networks enables bill review operations to maximize coverage and therefore cost containment," explains Shannon Frank, director of consulting services for Mitchell Workers' Compensation Solutions.
In an article in Mitchell's quarterly Industry Trends Report, she identifies an optimized network strategy as one of the 10 best practices in medical bill review. It is followed by a comprehensive out-of-network strategy.
"While an optimized network strategy is critical, up to 70 percent of medical provider charges may still be out-of-network," according to the report. "To combat these billing practices, best-in-class bill review operations must develop a strategy to realize savings in the out-of-network territory. Placement of services such as negotiation and specialty review within the solution hierarchy along with provider networks and ancillary service vendors should be carefully considered to drive optimal performance."
September 30, 2013
Copyright 2013© LRP Publications