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Clinical Bill Review


Fundamental Value

The missing component of bill review is medical necessity.

The traditional bill review process is valuable for payers by collecting medical bills, enforcing state fee schedules, applying PPO discounts, and delivering payments.

Using the associated medical records and the provider’s invoice, an Arbicare physician will perform a CPT code specific review of medical necessity. The resulting report allows the claims adjuster to issue payments only for necessary and appropriate treatment.

Medical
Bill
Fee
Schedule
Utilization
Review
PPO
Discounts
Explanation
of Review
Medically
Appropriate
Payments

Outcomes

Category
Outcome
Average Treatments per Bill
7.5
% of CPTs Not Medically Necessary
51%
Total Savings
$64,807.47
Average Savings per Bill
$2,817.72

Employees who are valued during difficult times are employees who recover

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