MRI’s Overpayment Recovery Mission Audit Objective In addition to identifying and recovering overpayments, MRI will assist clients in identifying prospective saving opportunities as a result of our audits and examination procedures and expertise in health claims auditing and recovery. This added- value service will help clients identify areas of overpayment, identify opportunities to significantly reduce future overpayments and develop strategies of risk control. MRI will employ the most effective procedures and provide our client a summary report listing errors, inconsistencies, and opportunities for process improvement. Our services are applied to all institutional and professional medical claims and include:
As part of our service, we will develop an episode-of-care profile using historical claim information to build patient-to -provider correlations, highlighting such overpayment situations as incorrect billing of services, overlapping billings, linked hospital and professional services, multiple surgeries, etc. Our unique recovery system sorts potential overpayments by patient, identifies the exact reason for overpayment and a single detailed statement is submitted to the provider of service. Our in-house recovery unit is staffed with specialists trained and experienced in recovering overpayments from providers and other third parties.
Auditing Tools and Approach - 100% of our client’s claims are reviewed on a “line-by-line” basis to identify overpayment, and significant dollars are recovered. MRI employs a unique data normalization and re-organization technique. We totally reorganize data to develop patient-to-provider profiles that provide us with unique ways to identify overpayments. Our use of claims history to build episodes-of-care and using them to see overpayment patterns has been a cornerstone to our success. Audit - MRI mines the data to find overpayments in the following areas: clinically based physician, hospital (inpatient, outpatient, surgical center), skilled nursing facility, specialized service providers (lab, chiropractic, DME, etc.), home health, and pharmacy claims, etc. Our bill negotiation, DRG validation and on-site hospital bill audit capabilities combined with CPT and RVU-based audits provide a unique single-source solution to our client’s cost containment needs. Recovery – MRI uses its own experienced recovery staff to recover overpayments identified during our audits. Personnel – MRI recruits and employs very knowledgeable and experienced medical claims auditors. RNs and LVNs are used to pre-screen bills, conduct onsite hospital bill audits and manage our DRG validation and bill negotiation services. Experience – MRI claims auditors have audited different systems and have developed procedures to screen databases for potential billing errors, identify overpayments, target billing aberration, identify potential fraud and abuse and aid in our successful recovery efforts. For these reasons, significant bottom-line dollars are recovered and cost savings are realized with minimal impact to our client’s resources. Education – In addition to identifying and recovering overpayments, MRI assists clients in identifying prospective saving opportunities by making changes to its policies procedures/memorandums and systems as a result of our audits and expertise in health claims auditing and recovery. This value-added service will help our client understand areas of overpayments and identify opportunities to significantly reduce future overpayments.
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