Negotiated Bill Review – Rarely Mentioned Risk Management Technique
The Negotiated bill review is rarely mentioned even by providers of the service. I often phone consult with investment companies examining the Workers Comp market to see if it is a viable area of insurance. The usual inquiring questions are what most WC insurance personnel discuss a large portion of the time. Those would be TPA’s, bill review, PBM’s, Rehab nurses, durable medical, etc.
The one that in my opinion is not used often enough is negotiated bill review primarily with medium-sized and larger surgical and hospital bills. If a TPA or carrier has a medical bill review company, there is usually a threshold where the bill is automatically reviewed for possible overcharges by the contracted bill review company. The bills are sometimes reviewed electronically which to me is not really a great type of bill review.
How I came to this article was someone at a very large governmental agency asked me if they could ask for a second opinion on the larger bills. There may be a conundrum due to agreements with the original bill review provider.
We have actually assisted in the referrals for a second opinion on the negotiated bill review. I am not so sure that a provider would want to hear from two bill negotiators on the same bill. We have never really run into any snags in the process other than possibly what is in the bill review contract.
Very surprisingly, there are some companies that are not even running the medium-sized and some larger bills through a network. Relying on your TPA or carrier to confer that the larger bills are receiving a hands-on negotiated review may be costing $$. The word automatically is not the one to hear in these cases. Do you know at what level your bills are being reviewed hands-on and not electronically? If not, you should check on that and see if the level is appropriate.
The appropriate level may be less than the auto-review level.
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