Managed Care Overview

Nurse review and specialty bill review are utilized by our medical bill partner as an added value for our customers. Nurse reviews are performed by a licensed registered nurse utilizing the standards of medical and surgical practice. They include, but are not limited to:

 

  • Clinical review of health records for work illness and injury relatedness
  • Medical necessity determination
  • Length of stay
  • Utilization reviews

 

Their specialty bill review and expert code review defines audits which require knowledge of medical procedures and diagnostic coding. Reviews are based on coding conventions defined in the American Medical Association’s Current Procedural Terminology Manual and Coding Guidelines. These reviews include, but are not limited to:

 

  • Correct coding
  • DRG validation
  • Comparative charge analysis with fair and reasonable payment recommendation
  • Modifier reviews
  • Comprehensive hospital line item charge reviews

 

CRS takes an aggressive approach to medical management and bill review. At CRS we treat our customer’s money like it is our money!