Expert Opinion

Medical bill audits are conducted by specialized medical personnel and can be either retrospective, aiming to statistically analyze the billing profile of the audited institution, or prospective, combining expertise, advanced technology, a customized rules engine and proprietary reimbursement methodologies to reduce costs.

Expert Opinion’s medical bill review can help reduce unwarranted charges by identifying imaging and diagnostic tests or medical procedures not adequately justified by the initial or end-diagnosis, while the actual length of hospital stay (LOS) is related to the average LOS of the DRG (Diagnosis Related Group) applied for billing.

A thorough clinical documentation audit is also performed to ensure that the medical records are comprehensive and permit safe auditing conclusions.