Medical bill review
Zurich takes a proactive approach to helping customers control workers’ compensation injury costs. Our rigorous bill review process is focused on cost-containment strategies to help reduce loss expenses while still ensuring injured workers have access to quality healthcare. Our dedicated billing review specialists use time-tested methods along with innovative new tools to identify errors related to billing and charges.
What is Medical Bill Review?
Medical billing errors can be extremely costly for businesses and, according to one estimate, as many as 80% of medical bills contain errors.1 A thorough medical bill review process addresses the potential pitfalls of those errors to help customers control their total cost of loss in workers’ compensation injury claims. The review process includes:
- Checking medical and hospital bills against state-specific fee schedules and fair and reasonable rates
- Identifying immediately questionable charges, billing practices and treatment options
- Researching to find discrepancies between billed charges and services documented
- Finding hidden double payments caused by complex billing practices
- Applying initiatives that can aid in finding cost-efficient care
- And much more Zurich’s Medical Bill Review is a core component of our managed care strategy.
Who needs Medical Bill Review?
Almost any business with a workforce is potentially liable for workers’ compensation claims related to employee injuries. With the high rate of billing errors mentioned above, the vast majority of companies can benefit from the cost-savings potential of in-depth billing review. Zurich’s Medical Bill Review services have resulted in an average 63% savings off annual billed charges — a figure that puts us among industry leaders in cost savings.2
Medical Bill Review services included
Zurich’s diligent billing review process includes steps for both general and more complex reviews where Registered Nurses bring their expertise to medical bill auditing services, looking out for issues related to high-cost billing with complex methods. Our knowledgeable team also integrates utilization review decisions with the bill review process to ensure treatment provided is appropriate for the workers' compensation injury. We also use high-level automated bill review technology to help us maintain consistency, accuracy and transparency.
PPO network solutions
Zurich leverages extensive national and regional provider networks to review bills for PPO-negotiated rates (possibly below fee schedule and/or reasonable and customary rates). We work with credentialed providers to help ensure high-quality service and we make sure those providers understand your return-to-work goals.
1. Gooch, Kelly. “Medical billing errors growing, says Medical Billing Advocates of America.” Becker’s Hospital Review. 12 April 2016.
2. Zurich Claims data.
This is intended as a general description of certain types of insurance and services available to qualified customers through the companies of Zurich in North America, provided solely for informational purposes. Nothing herein should be construed as a solicitation, offer, advice, recommendation, or any other service with regard to any type of insurance product underwritten by individual member companies of Zurich in North America, including Zurich American Insurance Company, 1299 Zurich Way, Schaumburg, IL 60196. Your policy is the contract that specifically and fully describes your coverage, terms and conditions. The description of the policy provisions gives a broad overview of coverages and does not revise or amend the policy. Coverages and rates are subject to individual insured meeting our underwriting qualifications and product availability in applicable states. Some coverages may be written on a nonadmitted basis through licensed surplus lines brokers.