Basic Bill Review Services Offered:
- Cost containment based on reduction of billed charges to applicable fee schedule guidelines.
- Apply network negotiated rates
- Provide verification of and compliance with applicable billing regulations and guidelines as established and/or adopted by the state’s Director of the Workers’ Compensation Division (i.e., state specific Administrative Rules, the Current Procedural Terminology (CPT) by the American Medical Association, the Healthcare Common Procedural Coding System (HCPCS) by the Centers for Medicare and Medicaid Services (CMS), and the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) by the World Health Organization).
- Make recommendations regarding payment (or non-payment) based on the above-referenced authorities, as well as ensuring relevant, complete, and accurate documentation in the injured worker’s medical record.
- Administration of inquiries from providers and insurers regarding all Bill Review-related issues
In addition to these basic services, the Majoris® Bill Review Team may also offer the following:
- Level of Service Review which includes a more in-depth analysis to determine whether or not provider charges have been billed with codes that accurately represent the level of service that is documented in the patient’s medical record.
- Receive bills and/or deliver review analyses and payment recommendations via electronic transmission
- Electronic data transmission of State-mandated bill review and payment information to the Workers’ Compensation Division.
Team Member Qualifications:
- All Majoria® Bill personnel are Certified Professional Coders by the American Association of Professional Coders and maintain current certification as professional coders.
- The staff holds Bachelor of Arts degrees from major universities, and they each have more than 25 years of experience in the bill review industry.
- Additional related experience that the Majoris® bill review staff members bring to the table include college level Human Anatomy and Physiology education, past certification from the Oregon Board of Claims Examiners, as well as numerous years of experience maintaining patient accounts for a major local hospital.