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Oct
2

What are work comp bill review “savings”

In the last few days of our Survey of Bill Review in Workers’ Comp and Auto, and once again the question that won’t go away is…

What exactly are bill review “savings”?

Are they:

  • below fee schedule/UCR?
  • below billed charges?
  • inclusive of negotiations or is that separate?
  • inclusive of clinical edits or are they separate?
  • derived from rules as well as dollar reductions
  • inclusive of duplicates – either full or partial, and what defines each?
  • net of fees or gross?
  • inclusive of network discounts?
  • inclusive of of adjuster denials of specific service lines?

 

And how do you pay for them?

Are the charges for bill review fair, transparent, logical, consistent with contractual terms, and consistent across bills?

Are they based on a percentage of savings, and if so, savings compared to what benchmark?

Why are some vendors’ fee schedule savings so much lower than others? Could it be because FS savings don’t incur additional charges, but all other savings types do?

We’ll have some answers in a few weeks.

 


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Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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