AMERICAN

MEDICAL AUDITORS

"Getting Bottom Line Results Since 1986"

Service, Integrity & Trust

Cost Containment Services

• Bill Audit

• Bill Arbitration & Negotiation

• Bill Reductions Signed and Agreed To

 

Bill Audit -

 

To help you avoid paying inaccurate, improper or unfair Audit charges, AMA will perform comprehensive

audits of hospital, physician and chiropractic  bills.

 

These bills are reviewed by specially trained registered nurses for:

 

Accuracy: Was the patient actually provided all treatments and medications indicated; are the charges and billing computations correct; is there any duplication of charges?

 

Applicability to the specific case: Are treatments related to the compensatory injury or covered illness; are tests and x-rays related to the diagnosis?

 

As part of the audit process, AMA can provide Retrospective Evaluation of Services. Using nationally accepted criteria including the applicable fee schedule, our nurse consultants analyze the medical record for appropriateness of admission, the length of stay, and the tests and procedures performed. When these criteria are not met, the bill and medical records are submitted to one of our consulting physicians for review and comment. Second physician opinions are also available. Our physician peer review consultants can determine the necessity of inpatient admission retrospectively. Relevancy of diagnostic tests and treatments to the diagnosis is also determined.

 

The AMA Audit Team.  AMA provides cost containment assistance with a network of health care professionals. For bill audit and review, we utilize only registered nurses who are knowledgeable of hospital procedures and policies. Each RN consultant receives AMA special training in professional evaluation of medical bills. Qualified physicians in each specialty are utilized by AMA to assist in determining necessity, relevancy, and appropriateness of treatment with written reports prepared for AMA to substantiate resolution of billing questions by AMA.

 

Our staff will be glad to scan your medical bills free of charge to determine whether a full audit is necessary and if it would be cost-effective.

 

Helping You Control Health Care Costs. Health care costs are continuing to rise at an alarming rate, far exceeding the general rate of inflation. The privately insured and private pay patients typically have paid the largest portion of our nation's health care bill. Not only are they paying the most, they often are being overcharged. Industry estimates indicate that employers and individuals are paying $6 to $10 billion annually for fraudulent and inept claims processing.

 

The current environment, with declining hospital admissions and caps on Medicare reimbursement and recommended reduction in the near future, serves as an incentive for hospitals and physicians to increase charges to the privately insured and private pay patients in order to maintain revenues. Economic pressures and ingrained practice patterns may even cause some providers to deliver services that are unnecessary. Furthermore, billing procedures are always subject to human error, and a simple mistake on a hospital bill can be very costly.

 

Advances in medical technology and treatment have also caused health care costs to escalate. The technology itself is more expensive, and new medical capabilities have increased the frequency and complexity of major cases. Quite simply, patients who, not so many years ago, would have died in accidents or of disease are being saved. These individuals often require lengthy courses of treatment, but have the potential for significant or complete rehabilitation.

 

Such cases require extended management to control treatment costs and to achieve the patient's return to maximum self-sufficiency and, hopefully, gainful employment. However, most physicians, hospitals and other health care facilities are not willing or able to provide overall management of these cases from beginning to end.

 

Despite these factors that serve to drive up costs, health care costs can be controlled. By effectively managing the purchase of health care services and closely monitoring those charges that are incurred, insurance companies and businesses throughout the United States are finding they can save an average of 30 to 60 percent on their total expenditures. AMA provides a comprehensive cost containment program that really works at saving you money and providing signed agreement letters and/or waiver of deficiency letters by the service providers.

 

Our experienced health care professionals provide assistance and support for:

• Jones Act

• Insurance

• Attorneys

• Self-insured/boat owners

• Longshoreman

• Workers Compensation

• Third party administrators

 

 

Our services are tailored to meet client needs and are offered in the most effective and efficient combination for the specific case in review.

 

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