Focus on large facility claims over $75K

1. Relevant Healthcare Cost Containment
Phone: (855) 328-5100
Fax: (708) 390-3891
www.relevanthealthcare.com
Relevant Healthcare Cost Containment
Bill Review/Audit
The US General Accounting Office showed 95+% of all hospital claims have errors,
overcharges, and charges for services never rendered or not associated with the diagnosis.
And in a recent study by PwC's Health Research Institute, it was noted that due to the
absorption of physician groups into hospitals this now allows doctors to code their billings to
insurers in order to charge a "hospital facility fee" even though procedures might not be
performed in a hospital.
Relevant’s Bill Review/Audit product focuses on accurate billing and coding, using the
guidelines developed by the government for federally funded programs as the foundation of
our recommended denials. The reviews we provide are written very clearly and logically and
presented in a format that makes it very easy for the payer and the provider to understand the
rationale behind the recommendations.
 Our typical turnaround time is 5 business days after receipt of all pertinent information.
At a minimum we need a copy of the claim, either the UB04 and itemized bill for facility
claims or the CMS 1500 for physician/ancillary claims. We may also need medical
records, operative notes, office notes, the plan document or other documentation.
 Average savings on claims:
o In Patient 8%
o Out Patient 12%
 Medical Bill Review appeal rate average is 14%

2. Relevant Healthcare Cost Containment
Phone: (855) 328-5100
Fax: (708) 390-3891
www.relevanthealthcare.com
Bill Review/Audit
Frequently Asked Questions
What does Relevant need to perform a bill review?
At a minimum, we will need a copy of the claim (both the UB04 and itemized bill for
facility claims or CMS 1500 for physician/ancillary claims). Depending on the particular
claim, we may also ask for: medical records; operative notes; office notes; a copy of the
plan document/insurance policy; utilization management / case management reports;
EOBs and/or denials; and any applicable reinsurance insurance policy.
How long does it take for Relevant to complete its bill review/audit?
Our typical turnaround time is 5 business days after receipt of all information, depending
on our current caseload and the quality of the information submitted. Clients are asked
to submit clearly legible documentation to expedite the review process. Requests for
medical records may require additional bill review time. Special requests for expedited
turnaround time are accepted on a case-by-case basis.
What does Relevant’s bill review report look like?
Our bill reviews are composed of two main parts. First, an executive summary that
explains our rationale for recommending a denial. Then a line-by-line review of the
itemized charges. A sample is available upon request.
Will Relevant use custom bill review guidelines?
Yes. Many claim payers have developed individualized policies for their applicable
situations. If those policies are provided to us before the bill review has begun, we will
incorporate those policies into our bill review report. Please ask us for more information.
Does Relevant provide a copy of their bill review report to the provider?
No. Our report is for the benefit of the client who asked us to perform the bill review. The
bill review is a series of recommendations based on our expert evaluation of the
submitted charges and/or other documentation. Claim payers may use our
recommendations as advice to help them adjudicate the reviewed charges. Final
decisions to accept or reject any portion of our bill review always rest with the claim
payer or re-insurer. Payers may provide a copy of our bill review report to the provider to
support the denial of services as recommended.