Medical Bill Review

Verify healthcare expenses and correct errors through retrospective billing review and reconciliation.

Carewise Medical Bill Review combines clinical expertise and analytical technology to identify and reclaim excessive and inaccurate healthcare charges. With more than 30 years of auditing experience, Carewise Health reduces healthcare costs by reviewing inpatient episodes for contracted and non-contracted claims.

• Hospital bill audit. The accuracy of healthcare claims is validated by comparing the hospital’s medical record documentation to the itemized bill. This ensures payment is made only for the services the patient received.
• Diagnosis related groupings (DRG) coding audit. Carewise Health confirms that diagnosis and procedure codes are correct and sequenced in accordance with national coding standards.
• Overpayment recovery. Overcharges discovered through a hospital bill or DRG audit are disputed and recovered on the client’s behalf.
• Clinical fee negotiation. Reductions in total billed charges are negotiated with out-of-network providers based on an analysis of medical judgment, cost data, and provider discount history.

Carewise Health is marketed by SHPS, Inc., a provider of integrated health solutions. It has a track record of securing hospital cooperation and recovering overpayments, including a 99 percent success rate in obtaining signed audit results agreements and 95 percent overpayment recovery within 60 days of audit completion. Clients include health plans, self-insured employers, third-party administrators, and government agencies.