3 Reasons Why Medical Bill Review Is Important in Workers’ Compensation (And How It Can Help Employers Maximize Savings)

By March 1, 2021 No Comments
Why Medical Bill Review Is Important in Workers Compensation
Medical expenses make up a large part of an employer’s workers’ comp costs. Those costs can be driven even higher because of excessive medical bills charges as well as billing mistakes like upcoding.  According to this report, about 80 percent of medical bills contain errors.  That number means you have a very high likelihood of your injured worker incurring excessive charges on their medical fees.  These billing errors can cost your organization a lot of money.Fortunately, this problem can be quickly addressed by workers’ compensation bill review services.   A medical bill review process is a vital part of any comprehensive claims management program with the sole purpose of helping clients make sure that they’re paying the fair amount for the medical treatment of their injured employees, thus maximizing savings. Hence its name, this service involves reviewing medical bills, checking them for accuracy and reasonableness to reduce it to the state fee schedule. 

 This article will talk about why medical bill review is vital in workers’ compensationAnd what employers can do to maximize the benefits of a medical bill review workers compensation service

1. Maximize Savings by Lowering Claim Costs

Companies that offer bill review services have experienced medical bill analysts, nurses, and state of the art automated bill review technology to ensure that every bill is audited for any mistakes (whether intentional or unintentional).  With the combination of tools, technical skills and experience of these people, they can easily detect duplicate charges on bills.

Medical review companies first review the correctness of the coding.  When they find out that the provided medical care level is coded higher than it needs to be, this is called upcoding, which elevates medical care costs if not caught.

These medical bill review specialists will then downcode the bill if they rule out that its original coding isn’t appropriate for the injury. 

2. Flexibility and Customizability

Create specific business rules to make the bill review process more streamlined.  Also, in the context of flexibility and customizability, medical bill review companies have highly experienced RNs in their roster. They can utilize the right fee schedule regardless of where the injured employee sustained his or her injury.  This is important, especially for employees who continuously travel like truck drivers.

3. Short Turn-Around Time To Increases Productivity

Some states impose penalties on late payment of medical care. That’s why the turnaround time on medical bill processing must be as prompt as possible.  Medical providers often have delays in sending the bill, which shortens the medical review company’s window in reviewing the injured worker’s statement.

The medical bill review company usually has a turnaround time of seven days or less to avoid late payment penalties to the hospital. 


Without a medical review, workers’ compensation costs can be higher than they ought to be.  Medical bill review workers compensation management services can help your organization save a lot of money and ensure your injured staff’s best health outcome.

If you’re an employer who is looking to recover costs for your organization by combating excessive medical charges, Call Novare right now at 866.532.1929