Medical Bill Review
Physician Led Technology Driven Reviews
With AMPS’ cost management solution, Medical Bill Review (MBR), all bills greater than $10,000 are audited for accuracy and reasonableness of charges. AMPS uses proprietary software that encompasses the aggregate knowledge accumulated over the past 14 years on 450,000+ audits and a line-by-line review performed by a physician review panel. The bills are corrected prior to payment and the payment levels are benchmarked relative to what Medicare would pay for the same service.
AMPS clients enjoy two core benefits of the MBR service.
AMPS reports benchmark a hospital’s gross billed charges, and the PPO’s net payable amounts (after discounting) against what Medicare would have paid. Even after PPO discounting, payment levels on hospital claims average over 250%. That is 2.5x what Medicare would pay.
According to studies performed by the U.S. Government and Equifax, over 90% of all hospital bills contain errors, to the detriment of the payer.
Regardless if the claim is in-network or out-of-network, a healthcare claim, worker’s comp, or an auto claim—hospitals charge the same way on all claims.
The AMPS MBR service provides the opportunity to scour the claim and make sure that anything the payer is paying for is correct and reasonable.
“Our first mission with AMPS was to make sure that the hospital bills we reviewed were accurate and reasonably priced before any other outside application like a PPO discount was utilized.”
— Mike Dendy, CEO
Advanced Medical Pricing Solutions
Why Is It So Important For A Physician To Review The Claims?
The goal is to be 100% accurate on every claim that is touched. Physician reviews provide an extra layer of knowledge; because they are in hospitals, operating rooms, and physician offices daily, they understand exactly what services are being rendered and why.
Egregious Medical Claim Examples
AMPS reviews tens of thousands of hospital claims annually and finds daily billing mistakes to prevent medical overpayments. Here are some savings examples that would have been paid without AMPS diligent oversight: