ACM

Medical Claim Review

• What do you look for in a provider bill audit?

  • Physician orders against actual services billed 
  • Medication administration log to assure prescribed meds were administered AND the dosage billed matches the dosage administered 
  • Operative reports if the supply/implant charges are excessive 
  • Each service for appropriateness/medical necessity 
  • Experimental/ Investigational Treatment Review 
  • Chemotherapy / Radiation Therapy Protocols and Audits 
  • Pharmaceutical Regimen appropriateness 
  • ER reports for accident details when MVA or other accidents involved to determine plan liability and/or subrogatable issues

• Do bills really need to be audited?

  Yes. As reported by the Wall Street Journal, 98% of all hospital bills contain errors, 75% of these errors are unfavorable to the paying party.

• How does ACM charge for this service?

  ACM's Claim Auditing service is risk-free. ACM charges a percentage of actual realized savings. If there are no savings as a result of the audit, there is no charge to the client.

• How is it determined if a bill is a good candidate for audit?

  For claims between $20,000 - $50,000, ACM feels they should be reviewed for audit potential. For any claim > $50,000, ACM feels an audit is warranted.

• How do I contact ACM for more information?

  Please contact ACM Marketing Department at (317) 655-4668; or via email at andy.tibbets@akesocare.com.

• What type of savings can be expected when a bill is deemed to be a good candidate for audit?

  Although each situation is unique, ACM has found that a minimum of 12-15% can be saved when an audit is conducted.