tci Part B Insider - 2003 Issue 8

MEDICAL REVIEW: Bring Medical Review Into Greater Focus

Why is the insurance carrier picking on you? It may seem random, but there's usually a reason. If your carrier appears to have singled you out for intensive review of all of your claims, either before or after payment, then chances are you were billing for something in a way that attracted the carrier's attention. Figuring out what triggered the radar can be the first step to extricating yourself. Focused medical review can take a few different forms, billing experts say. It can involve prepayment or postpayment review of claims. It can also involve a random sampling of your...

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