Medical Record/Bill Review

At Healthways Services, we are experts when reviewing medical records, and the prepare of a comprehensive summary/report according your needs or service. This summary/report may include the following, depending on the needs of the case or claim:

• Summary and interpretation of document content
• Chronology of pertinent records
• Identification of missing/incomplete records
• Identification of pre-existing medical conditions
• Identification of compliance with medical recommendations

The Medical Record Review summary and analysis plays a key role in the preparation of our Earning Capacity Evaluations and Life Care Plans. A Medical Record Review Analysis/Report can also prepare for claim professionals that will provide detailed information necessary for evaluating a claim. (Please refer to our litigation support section for potential client’s that would benefit from this service).

Medical Bill Audit

Healthways Services are not expert witnesses on auditing medical bills; however, upon medical review, we could provide testimony on the findings or results of an audit completed by our Agency or subcontracted firm depending on the needs of the your case or claim.  Therefore, depending on the needs of the case or claim, we would consult with an outsource cost containment auditing firm who are considered to be experts, and provide superior medical fee guideline review services that are usual, customary & reasonable (UCR) analysis, according to the needs of each case or claim by using The American Medical Association (AMA). Since, we have several years of experience understanding medical record review/bill audits, we will oversee and make sure that the outsourcing firm, reflects an audit philosophy that recognizes the need for a distinct balance of detailed personalized review by their qualified medical coding professionals, and an accurate efficient system for the generation of a clear and concise product guideline for our clients.  All bills for medical care are evaluated in accordance with the rules and guidelines as established by each State fee guidelines of the case or claim. Again, we will make sure that the retail cost is usual, customary and reasonable, according to geographic regions for services that are scheduled within the State of the medical fee guideline.

Healthways Services hospital bill auditing services are also subject to be subcontracted depending on the needs. If a subcontractor is used, the subcontractor will audit off site. Again, our staff are well trained and experienced professionals that will oversee who possess state-of-the-market knowledge of medical facilities, according to each unique case.  Therefore, by allowing our agency to provide medical review services will give your organization a formidable advantage when reviewing medical bills by utilizing our services.

Healthways Services will make sure that the outsourcing company will develop a consistent and reasonable payment itemized report of the bills for each individualized client, and will comply nationally with the statute and tightly controlled medical costs.

Services that could benefit from the medical bill audit service include catastrophic case management, litigation support/testimony, life care planning and other medical record review issues. (Please refer to our litigation support section for potential client’s that would benefit from this service).