15th National Workers' Compensation and Disability Conference

November 14-16, 2006 Mandalay Bay Resort & Casino, Las Vegas

Meet with us in Booth #117 to check out recent developments in the area of cost containment. Be sure to enter for your chance to win a new 4GB iPod nano!

If you haven't registered, there's still time. If you're simply looking for the opportunity to network with your industry associates, register for the Expo Only option – it’s free!

BillChek service will begin in Kentucky and South Carolina starting January 1, 2007. Extensive regulatory analyses in these states indicate savings potential within the boundaries of the fee schedule directives.

South Carolina’s inpatient and outpatient health care facilities are paid 40 percent over the Medicare reimbursement level, one of the highest percentage levels in the country. BillChek services in South Carolina focus on applying the appropriate billing rules prior to fee schedule payment. Inpatient DRG validation also is included in the new service.

Kentucky uses a “cost-to-charge” ratio to determine reimbursement. BillChek identifies billing errors for outpatient hospital services before applying the ratio to determine the appropriate reimbursement rate for the facility. The Qmedtrix methodology will also be used to review ASC, ambulance and out-of-state inpatient hospital bills, as Kentucky’s fee schedule also provides for the bill review to a “fair, current and reasonable” level for these facilities.

If you have questions or wish to begin service in these states, please contact your account manager, or contact our customer service department at (800) 833-1993 or customer-service@qmedtrix.com.

The past four years have seen increases in the number of outpatient surgical procedures performed during a single surgical visit.

A significant reason for the increase is the necessity to document any and all procedures performed, regardless of whether those charges should be paid or not. Often times the charges are paid, even though the provider is not entitled to payment.

Outpatient hospital and ambulatory surgical center facility bills should undergo careful review in order to determine appropriate payment.

1. Payment for secondary surgical procedures at multiple procedure discount
2. Surgical procedures that are a component or are inclusive of another procedure (also known as unbundling)
3. Duplicate charges, particularly when billed using different codes

Coding errors for bills with multiple procedures can be difficult to find, so BillChek uses a twofold approach - electronic algorithms and manual review - to find these and other types of errors when multiple surgical procedures are billed, providing the best protection against overpayment.