HELPING PAYERS FIGHT MEDICAL BILLING FRAUD...
Transcript of HELPING PAYERS FIGHT MEDICAL BILLING FRAUD...
HELPING PAYERS FIGHT MEDICAL BILLING FRAUD AND EXCESS COSTS
BillChek®
BillChek® is grounded in a fusion of human and artificial intelligence.
The Qmedtrix algorithm-based methodology calculates appropriate facility and ancillary medical payments using data from public and private sources. BillChek® is available for out-of-network workers’ compensation and automotive medical claims bills.
To identify savings opportunities and fairly reimburse providers, Qmedtrix reviews each state’s specific statutes, regulations and case law, analyzing data for changes in billing patterns and trends.
BillChek® identifies and corrects:
• Unbundling – separate billing-related services
• Upcoding – using “trauma” or “with complications” to exempt charges from fee schedules
• Duplicate charges, particularly when billed under separate codes
• Excessive hospital charges triggering outlier or stop-loss thresholds
• Fragmented charges
• Medically-unlikely procedures
• Unreasonable procedure charges
BillChek® recommendations are supported by Qmedtrix-led dispute resolution team. Provider inquiries, reconsiderations and dispute resolution support services can be included in the cost of the services, depending on agreement terms.
The Qmedtrix methodology incorporates historical data, a physician-based expert knowledge of medical procedures and billing practices, and extensive legal and regulatory due-diligence to deliver accurate and reasonable payment recommendations.
To talk to a Qmedtrix representative, please contact us at [email protected].
BillChek® is an innovative program designed to maximize out-of-network medical bill savings,
helping to drive costs down and savings up while providing supportable recommendations for
carriers and other medical bill claims payers
• Provides greater savings than “prompt pay” methods
• Focused on fair reimbursements to both payers and providers
• Patent-pending software leverages proprietary and public data analytics
• Methodology supported by physician-based expertise
• Recommendations supported by Qmedtrix-led dispute resolution team
• Concise recommendation summaries
• Bills received via electronic data interface (EDI), secure email, fax or mail
Bill types
• Ambulatory surgical center
• Emergency room
• Inpatient hospital
• Outpatient hospital
• Ambulance
www.qmedtrix.com
© 2014 Qmedtrix Systems, Inc.
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Read all about it at www.Oregon100Best.com
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Audit ● Tax ● Advisorywww.Grant Thornton.com
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In 1955, Be y Roberts le! behind a homemaker
lifestyle to fi nd fulfi llment in an inspiring and varied
career that included practicing law, serving as a legisla-
tor, and eventually becoming the fi rst woman appointed
to both the Oregon Court of Appeals and the Oregon
Supreme Court. Join Oregon Women Lawyers to celebrate
Justice Roberts’ life and career at a CLE and reception
marking the release of her autobiography, With Grit and
By Grace: Breaking Trails
in Politics and Law.
Two panels will discuss the
themes and events in Justice
Roberts’ groundbreaking
book, and the evolving
role of women in Oregon’s
political, legal and social
landscape. Panelists include
Justice Roberts, former
state legislators Norma
Paulus and Gretchen
Kafoury, Justice Virginia
Linder, Judge Adrienne
Nelson, and a# orneys Liani Reeves and Cashauna Hill;
PSU Political Science Department Chair Melody Rose
will moderate. MCLE credits pending. Registration fees
include a copy of the book.*
Immediately following the CLE, OWLS members and
the public are invited for a book signing and reception.
Justice Roberts will read an excerpt from her memoir,
which will be available for sale. Reception includes hors
d’oeuvres and a no-host bar.
3-5:00 pm CLE and Panel Presentation, Madison Room
5:00 pm Public Reception and Book Signing, Miller Pavilion
*Student registration price does not include a copy of book.
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With Grit And By Grace:Breaking Trails in Politics and LawAn autobiography release CLE and reception
2008 OWLS Spring CLE
Friday, June 13, 2008, 3:00 PM
Public Reception, 5:00 PM
Oregon Historical Society
1200 SW Park Ave, Portland
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The evolving role of womenin law: the life and career of a Lawyer, Legislator, and Supreme Court Justice
Friday, June 13, 2008
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