Contingent Fee-Based, Audit and Negotiation of Appropriateness of In/Out Patient Facilities Bills In Lieu

of or In Addition to, a Traditional Accuracy Style Bill Review

HR Specialty Products & Services Catalogue Executive SummaryA No Frills Distillation of Vendor’s Marketing Collateral

Thomas A FerencePresident & CEO

Human Resources Mining & Distribution CoLocating, Validating and Accelerating HR  Innovation

 Office: 219-662-0201Cell: 630-240-2583Fax: 219-661-0236

e-mail: tference@hrmdco.comWebsite: www.hrmdco.com

Audit and Negotiation of Appropriateness of In/Out Patient

Facilities Bills • Traditional facilities bill review services evaluate only the accuracy

of the coding and not the appropriateness of the amount of the charges

• This service deploys proprietary heuristic software that reformats the data on the itemized bill to enable Medical Doctors and Compliance Specialists to identify and remove erroneous charges

• The platform works from a “Benchmarking and Proper Coding” perspective that includes the hospital’s chargemaster procedure costs, federal data and other parameters so as to also focus on what is  “Fair and Reasonable” pricing for every item / service - not just the accuracy of the billed charge

Audit and Negotiation of Appropriateness of In/Out Patient

Facilities Bills • Assigned analysts as supported by ERISA attorneys secure a

post-audit signed agreement from the provider before the employer / ASO vendor is presented with the newly reduced bill amount for payment so as to virtually eliminate any balance billing, reconsiderations or possible litigation

• Covers in our out-of-network providers• Nightly EDI and encrypted transmissions of HCFA/UB/EOR data

from payer assure timely and HIPAA compliant processing • 95%+ success rate with a 32% average savings

Accuracy Type Review vs. Appropriateness Type Review

Appropriateness Review

Appropriateness Savings

Next Steps• This product/service is contained in the HR Specialty

Products & Services Catalogue™ • Operational level details about this particular service

provider can be obtained in conference with the vendor• The HR Mining &Distribution Co. is an independent and

contracted representative of the vendor• Upon your request, we will arrange for an introduction

that can range from a simple, quick conference call to a services overview / system demo

• Tom Ference 219-662-0201 (Chicagoland area) or tference@hrmdco.com

• Thank you for your potential interest in this fresh thinking