Workers Compensation
Qmedtrix offers BillChek® and Strategic Negotiation services for workers’ compensation medical bills. These services may be customized by jurisdiction to each client’s specific needs in order to provide the most appropriate reimbursement recommendations.
BillChek, a national specialty medical bill review service, identifies and corrects inflated, inaccurate and unreasonable charges for out-of-network facility bills. Qmedtrix uses proprietary physician-directed edits, as well as nationally recognized correct coding standards and edits to help to identify medically unlikely charges, duplicate charges, unbundling, upcoding, and other billing abuses. Excessive charges are identified using an algorithm-driven rules engine and are compared-to and validated against national public and private billing data. Charges are geographically-adjusted to a fair and reasonable, or usual and customary, dollar amount.
Strategic Negotiation is appropriate where repricing is not feasible or by client preference. This is not a prompt-pay service; rather Qmedtrix negotiators review each bill by applying the BillChek methodology first. Then, other data is utilized to determine an error-free and reasonable reimbursement amount that accurately reflects the reasonable costs of the procedures and facility usage. Negotiators seek to secure signed settlement agreements with the provider to prevent balance billing to the claimant or payer.
Service Features:
- May be customized by jurisdiction and by bill type
- Focus on accurate and appropriate reimbursement that is fair to the provider and payer
- Data-driven, process-based methodology supported by a physician-based understanding of bill review, medical billing expertise, and knowledge of statutes and case precedence by jurisdiction
- Detailed monthly results and status reporting