Hospital Bill Audit

MRI has a progressive compliance strategy to ensure that billing for Commercial, Stop-Loss and Medicare payments for outliers and services is appropriate. Our strategy is designed to ensure the greatest level of scrutiny to help identify potential problems. We will perform a line item review of patient records to determine whether care is reasonable and necessary.

Line Item Review For Appropriate Billing & Documentation
The primary objective of our service is to ensure that services are ordered by a physician, consistent with industry standards and provided to the patient according to hospital protocol, documented in the medical record, and billed correctly.

Reduced Insurance Denials
For defense audits, we act on behalf of the hospital, handling the entire audit process, and, finally, settling the account. Here is how our service benefits your facility:

• Improved cash flow
• Accelerated insurance payments
• “Clean” hospital bills
• Monitored departmental charging procedures
• Reduced insurance denials
• A monthly management and statistical report
• On-site review by MRI Nurse Auditors
• Customized training for departments and staff

Sample Review Findings
The primary objective of the Billing Review Program is to insure that billed services are ordered by a physician and provided to the patient according to hospital protocol, and that both are documented in the medical record. The sample review findings for a client Health System, for the most significant revenue producing ancillary departments, are summarized below: