You Shouldn’t Pay the Price for Costly Medical Billing Errors

Unfortunately, billing abuse is an unavoidable issue in today’s modern healthcare system. Despite that fact, Beacon HCI (formerly MedExpense Solutions) utilizes an extraordinary tool that can save healthcare payers thousands upon thousands of dollars.

A hospital bill and cash laying on a desk.

The traditional time-consuming process of a medical record audit is frustrating. Whether you are a TPA, insurance company, medical cost-sharing program, or help manage union benefits, you deserve an advocate to help protect your clients, members, and employees from overcharges. We provide you with an all-encompassing solution for your clients, ensuring that the charges billed are accurate for the care you received.

Our services can also help Self-Insured Groups, Reinsurance—Stop Lost carriers, and Trade Organizations members.  If you're a healthcare payer, and you’re faced with a significant amount of medical expenses, you can benefit. 

Medical Billing Errors
Compliance bill reviews are the foundation of cost reduction solutions. A compliance bill review focuses on a vast amount of Federal and State Regulations and coding guidelines that are hidden deep in the likes of statues, acts and coding manuals that are present to protect healthcare payers. Pat Palmer, alongside her highly skilled team of experts, has invested more than 25 years to bring these regulations and guidelines to light for healthcare payers. We help payers achieve a financial benefit by identifying the following:

·      Duplicate charges: Routine services, supplies and equipment individually billed constitutes duplicate charges as they are already factored in the room or procedure billed. 

·      Room charges: ICU is one of the most expensive rooms in the hospital. As a patient’s condition improves so does the need to be transferred to a stepdown room. 

·      Operating rooms: Often, operating rooms can cost as much as $200 or more per minute. The difference between two hours and 4 hours can cost you $24,000.00.

·      Outpatient procedures: Unlike operating room charges, outpatient procedures are generally billed based on the procedure code, not a per minute fee. You can only imagine the price difference between a closed and/or open procedure, laparoscopic procedure, and robotic procedure. 

·      Canceled Tests or Procedures: Most often canceled tests or procedures will find their way to the billing statement.  

·      Medications: Discontinued medications can be charged in error on a hospital bill. The quantity billed can often contain simple mistakes such as an extra “0” being placed at the end of a number by the billing department.

These are just a small portion of the types of errors for which we adjust. Using our proprietary software tool, we're able to quickly identify hundreds more to ensure that you receive the maximum amount of savings you're entitled too.

Instead of medical record audits, Beacon (formerly MedExpense Solutions) provides a compliance analysis of billed charges through a review of the detailed itemized statement and UB-04. Medical Record Auditing involves reviewing hundreds of medical records in great detail, which is very time-consuming.  Alternatively, our compliance analysis utilizes a line-by-line review of the itemized statement based on Federal regulations and guidelines, taking a significantly less amount of time to meet restricted reimbursement guidelines imposed on payers like you.

How a Compliance Review works?
Initially, a client will upload a UB-04 and detailed itemized statement to a secure HIPPA compliant site. We then enter the UB-04 and itemized statement into our proprietary database system. The database system is integrated with all federal regulations and guidelines and provides the initial analysis.  Along with the initial analysis, our team of compliance investigators will perform a review of the findings to ensure the errors identified are accurate.  A report is then uploaded into the client’s secure portal within five (5) business days of ineligible charges, including the explanation of the code associated with each item. The client would then proceed with normal claims processing method for claim reimbursement.  

Who We Help
We help Third Party Administrators (TPA), Self-Insured Groups, Reinsurance—Stop Loss carriers, Trade Organization members and any other healthcare payer exposed to significant medical expenses. 

Leading the Way to Cost Containment
Pat Palmer, the “Robin Hood of Medical Billing,” educates payers about the healthcare billing abuses and founding establishments within the healthcare industry to combat the waste and abuse that is ramp in the industry.  She's been a guest on NBC Nightly News, Fox Business with Gerri Willis Report, ABC's Prime Time Live, NBC's Dateline, and CNN. With 20+ years of experience, she fights medical bill errors for consumers and corporate America with a passion for increasing consumer awareness of abusive billing practices.  Beacon (formerly MedExpense Solutions), being her most recent endeavor, is set to lead the way in cost containment, as she did in former successes, by offering a revolutionary money saving technology system for all healthcare payers.

Mike Childress