MEDICAL BILL REVIEW SERVICE

HCRG provides a fully comprehensive medical bill review service nationwide. Our best in class partnership, proven technology platform, efficient and accurate workflows, PPO networks, application of fee schedule and ground rules by state all work together to generate the maximum saving for our clients. We provide the following services:

• STANDARD BILL REVIEW
• COMPLEX BILL REVIEW
• COMPLEX BILL NEGOTIATIONS
• BILL REVIEW EXPERT WITNESS

Standard Bill Review

We define Standard Bill Review as all bills for treatment that are past the First Aid Status and non-complex.  The majority of physician services fall in this category. 

Physician services include:
• DME
• Pathology and Laboratory
• Ambulance
• Anesthesia
• Pharmacy
• Radiology
• Surgery
• Medicine
• Physical Medicine
• Evaluation and Management

This review is executed mostly through Bill Review rules and audit automation.


Customer Service
Call:  (562)-945-7224

Corporate Address:  
6571 Altura Blvd.,
Buena Park, CA 90620

“HCRG has saved clients millions of dollars in Bill Review expenses within the last 5 years.”

Complex Medical Bill Review

Complex Medical Bills are bills related to inpatient, outpatient, and services rendered in an ambulatory surgery center.  These bills are high dollar bills with complex billing methods such as the use of DRG and/or APC.  These bills require multiple levels of audit including clinical, technical and coding by specific experts. 
A medical chart review may also be required to match medical services with billing.

Specialty Medical Bill Review

Specialty bills are those bills that are high dollar and complex.  They do not fall into the regular inpatient and outpatient category.  These bills are reviewed utilizing manual methods in its entirety by experts.  Each of these specialty bills has specific rules that cannot be automated. 

These include:
• Transfer of cases from acute case to acute care.
• Transfer of case from acute care to rehabilitation, long term care or other specialty hospital.
• Inpatient rehabilitation hospital
• Psychiatric hospital admissions
• Long term care hospital admissions
• Skilled nursing facility admissions
• Other

Complex Bill Negotiation

Complex bill negotiation is an additional service that we provide for high dollar and complex bills.  Once the bill is re-priced per fee schedule, we negotiate with the provider for further discount percentages.

Bill Review Expert Witness

Providers usually accept the re-priced bill amount most of the time.  There are occasions when the providers dispute the amount and choose to go to court.  As a bill review service provider we stand by our review and we are prepared to go to court to defend the bill review.  We provide the services of an expert witness to complete this task. 

HCRG Bill Review Program Structure Include:

• Proven web-based sate specific software application
• Fee schedule rules and regulations
• Duplicate check
• Fraud detection
• Client configurable requirements
• UR integration
• MPN check
• Coding Review
• Automatic referral to complex and specialty review
• Four levels of audit
• State and NCCI reporting
• Advanced reporting system

Results we deliver:

Compliance with fee schedule and payers rules
High cost savings in standard and complex specialty bills
Accurate and fast reviews with detailed EOB
Defensible reviews in complex/specialty bills
Overall reduction in medical cost
Fast turnaround time
Timely reporting

HCRG difference:
Our investment in R&D that ensures continuous updates of programs and new solutions
In-house clinical, billing and coding expertise
Clinical knowledge of medical services
In-house expertise to conduct complex and specialty bill review and medical chart reviews
In-house capability to conduct advanced negotiation on high dollar bills        Expertise in integrating state laws, case laws, coding technicality and clinical aspects of bills to obtain best savings
Advanced data analytics
Ability to deliver data driven results