A simple review of hospital claims is not a sufficient means of identifying billing errors and overcharges.  In order to reduce payments for billing errors and overcharges, a more thorough review needs to be undertaken.  The M-Audits process involves two distinct, but important steps.

Step 1: Financial Review – Line-by-line comparisons of the supporting hospital claim itemization are the only valid way to adjust for incorrect billing practices and to supply corrected standard fees for ‘usual and customary’ areas of treatment, supplies, etc.  M-Audits performs the audit of  hospital or physician bills to determine if there were incorrect charges.

Step 2: Clinical Review – M-Audits uses trained medical staff and physicians to provide a more thorough review of claims reaching a certain dollar threshold.  This includes a review of the medical records and treatment protocols to make certain that you are only paying for services that were actually rendered.

M-Audits helps ‘at risk’ entities such as self-funded employers, insurance companies and re-insurers reduce costs by providing:

1. Prospective Audits – Auditing of large hospital and questionable physician bills prior to payment.
2. Hospital Bill Audits – Review large hospital bills for inappropriate billing.
3. Physician Bill Audits – Review physician bills for inappropriate billing.
4. Hospital Negotiations
5. Workers' Compensation Claim Audits – Review workers' compensation claims for appropriate provider billings.
6. Eligibility Audits – A thorough review of all employees and dependents to help ensure that only eligible employees are enrolled on the plan.  Typically we see 5 – 14% of dependents on a plan are ineligible to participate. This costs your company a significant amount of healthcare dollars. Click here to learn more about this process.
7. RAC Audits

• Reduction in Claim Expenses
• Re-bundling of Charges
• Coding Review
• Error Removal and Explanation of Revised Charges
• ‘Usual and Customary’ Review by Revenue Code
• Line Item Bill Review
• Verify and Eliminate Charges for Supplies and Services not Rendered by a Facility
• Verify and Eliminate Charges for Supplies and Services not Ordered by a Physician
• Eliminate Duplicate Procedure Billing
• Correct Errors in Human/Data Entry
• Correct Multiple Pricing Errors
• Correct Inappropriate Coding Combinations

• M-Audits is committed to accurately reviewing Medical Claims
• M-Audits is committed to reducing your claim costs as a result of over billing and erroneous billing
• M-Audits is committed to helping you manage your claims by making sure you pay only for appropriate charges on each hospital bill
• M-Audits is committed to helping you manage your healthcare costs

• M-Audits is committed to making sure that your Medical Claims are properly billed
• M-Audits is committed to reducing your claim costs by ensuring that you don’t pay for services not rendered.
• M-Audits is committed to helping you manage your healthcare costs
• M-Audits Patient Advocacy Group is committed to helping your employee understand the claim review process.