Medical Bill Review: Using Medicare Fees To Manage Third Party Liability Costs

Motor vehicle accidents led to more than 2.5 million emergency department visits in 2017, according to the CDC’s most recent estimates. Emergency room and other hospital visits can be costly for insurance carriers, as facility charges are some of the highest fees that carriers face when paying for medical treatments related to auto accidents.

In fact, a recent Mitchell analysis of third party bills revealed that while inpatient facility bills represented only 1% of all of the bills a carrier evaluated, they made up almost 11% of total charges evaluated. Meanwhile, outpatient facility bills represented 22 percent of all bills evaluated, but 33 percent of total charges.

While facility and other medical bills within third party demand packages can be particularly pricey, many claims organizations do not have a consistent method or benchmark available for referencing costs.

In addition, there may be issues with non-standard facility itemizations being provided instead of the UB-04 bill-level details that are necessary for processing appropriately with Medicare.

This often causes adjusters to spend extra time looking for potential adjustments and sometimes results in insurance carriers paying more than the fair price for third party claims.