Prepay Itemized Bill Review
97% of all hospital claims contain undetected charge errors within the uniform bill. At CERIS, claim analysis and reviews are conducted by licensed multispecialty facility nurses based on CMS non-separately billable guidelines and current professional practices. The CERIS team of certified review nurses are able to consistently identify and remove errors like duplicates, reusable equipment, routine supplies and services, time increments, unit and quantities, and hospital acquired conditions. Additionally, CERIS has a long-standing quality control team of highly trained nurses responsible for validating the accuracy and appropriateness of every review. On average, CERIS’ certified review nurses have 21 years of experience per employee. The following examples demonstrate the impact CERIS’ team of certified review nurses can have on prepay itemized bill review claims.
CASE STUDY 1
- 88 day inpatient stay, $4.4M total billed charges
- Certified review nurses identified $439K in disallowed charges
- $90K Disallowed based on application of client clinical policy bulletin
- $115K Hemodialysis billing code error
- $39K Duplicative ventilation management charges
CASE STUDY 2
- 4 day stay incorrectly billed as outpatient
- Certified review nurses identified $575K in disallowed charges
- $287K Recovery room charge denied as billing error, provider billed charges for operating room cost separately
CASE STUDY 3
- 59 day inpatient stay, $2.4M total billed charges
- Certified review nurses identified $380K in disallowed charges, in conjunction with AI
- $168K disallowed charges in routine nursing administration services