Medical bill review/audit focusing on accurate coding and billing: 

Medical Bill Review/Auditing Services

National studies report 90% of the claims submitted to payers contain billing errors. EthiCare Advisors’ proprietary, state-of-the-art audit program is designed to identify those costly mistakes and to give the claim payer the tools needed to adjudicate the claim correctly.

EthiCare’s audits focus on accurate billing and coding using the guidelines developed by the government for federally funded programs as the foundation of our recommended denials. Our audits include reviews for unbundling, upcoding, duplicate charges, incompatibility with gender or diagnosis, and correct coding norms taken from authoritative sources and industry publications.

Our audits are written in plain language and presented in a logical format making it easy for the payer and provider to understand the rational behind the recommendations. We are also able to provide upon request the name of the reference(s) used, the chapter(s)/section(s) and page(s) utilized to make our recommended determinations.

EthiCare Advisors’ focus on accurate billing and coding combined with use of authoritative references rather than pricing cuts has made us a respected leader in the auditing community by both payers and healthcare providers. We have seen examples of providers changing their billing practices after reviewing EthiCare’s audits.

Our fee to perform an audit is based on the dollar amount of the claim and not the percentage of savings. The maximum fee we charge is $5,000.00. This fee structure generally saves our clients more money net when compared to other vendors charging on a percentage of savings basis. Further, our methodology is compliant with numerous federal and state statutes and rules governing the issue of auditing medical claims.