Companies involved in the claims process require proper bill review to determine the usual, customary, and reasonable (UCR) value of medical expenses based on total bill charges. Medical Billing Experts analyze hospital and other medical provider comparisons to ensure individuals are billed accordingly. Let’s explore how accurate and organized medical records and medical billing are an important aspect of an efficient claims process.

What is a medical record and why should one be organized? 

According to a study by Johns Hopkins Medicine, researchers found that patients who kept a personal health record enjoyed better health overall. When caregivers and medical providers have a clearer picture of someone’s health, they can act faster in the case of an emergency. Records over one year old can be organized and filed away, however, documents from the past year should be kept readily accessible, including:

• Family Health History
• Personal Health History
• Doctor Visit Summaries and Notes
• Hospital Discharge Summaries
• Pharmacy Printouts
• Test Results
• Insurance Forms
• Legal Documents

How medical records impact insurance claims

As it pertains to the claims industry, there are several important reasons to maintain and securely store medical records. An example would be a workers’ compensation case,  where a medical record for an insurance claim can be hundreds to thousands of pages for one specific incident or injury. According to Keche’s Law Group, insufficient medical documentation is the most common reason that workers’ compensation claims are denied or delayed.

Platforms like Wisedocs allow insurance carriers, legal firms, and medical evaluation clinicians to easily access, upload, share, and sort through indexed and chronological medical records for:

• Tort law
• Medical malpractice
• Workers’ compensation
• Personal injury
• Disability claims

What is a medical bill review?

A medical bill review is the process of reviewing and sourcing errors in medical billing. In the claims space, it is to ensure the billing is accurate as per the insurance claim. It is predicted that as many as 80% of medical bills contain errors in the US, and these inaccuracies cost companies higher payouts.

What is a Medical Billing Expert?

Medical Billing Experts audit medical records related to the charges billed to ensure accuracy. Essentially, a Medical Billing Expert ensures the amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service, also known as the usual, customary, and reasonable (UCR) amount.

Medical billing experts in claims

When involved in the medical claims process, an organization on the receiving end of a claim will want to ensure billing accuracy as it impacts their payout. 

An example, personal injury cases are the number one result of medical bill lawsuits because they are often listed as not within the expected parameters of the payer.

How Wisedocs supports bill reviews?

In the summer of 2022, Wisedocs assisted an Independent Medical Evaluation company relying on manual document processing for claims and medical records. Once partnered with Wisedocs, the company saw an improved document processing speed of 70%. The company stated they “had a lot of companies pitch their document sorting software over the years, but none have ever come close to what Wisedocs has to offer.” Contact our customer support team today and find out how Wisedocs can assist you with medical data management.

There are a variety of companies and cases who can benefit from organized medical records for claims. Patients who receive extensive medical care, lawyers who deal with medical litigation, Medical Record Experts analyzing their clients’ information, and even hospitals and medical offices that want to provide ethical care. Wisedocs automatically sorts and organizes records plus generates medical chronologies allowing organizations to process in hours rather than days.