Question 1

What percentage of medical bills contain errors?

Accepted Answer

90% of medical bills contain errors

Question 2

How does WellRithms detect medical billing errors and what processes prevent these errors from influencing reimbursement recommendations?

Accepted Answer

WellRithms has built classification algorithms into its proprietary software so that the errors outlined above are detected and corrected prior to a physician review of the medical records. Furthermore, standard industry accepted edits, such a CCI (Correct Coding Initiative), are applied prior to repricing. Our algorithms are architected to find questionable, abusive, and fraudulent charges and is continually tuned and updated to catch and flag suspicious charges for physician review.

Question 3

What are some examples of errors that WellRithms commonly identifies?

Accepted Answer

WellRithms has found one of the most common errors on a bill is inaccurate Place of Service (POS). Misidentifying an Ambulatory Surgery Center (ASC) as a hospital, or a doctor’s office as a surgery center, can greatly influence the reimbursement. It is important to understand that repricing a claim through a PPO, RBP, or another cost containment strategy will not identify this error thus resulting in significant overpayment.Another common error is found through a disparity between the medical records and the billing statement:Services added that were never performedImplant devices billed that were never usedServices billed that are not medically appropriateGrossly inflated provider chargesDrug choices and costsSupplies used and costs

Question 4

Who is reviewing my medical bill today?

Accepted Answer

If WellRithms is not reviewing your bills, likely no one.

Question 5

What type of medical bills does WellRithms review and reprice?

Accepted Answer

WellRithms reviews and reprices all inpatient hospital bills, outpatient hospital bills, ambulatory surgery center bills and professional bills. We do not reprice any dental or outpatient pharmacy bills.

Question 6

What data sources does WellRithms use to determine its recommended reimbursement?

Accepted Answer

WellRithms reference rate is based upon the English common law principle of quantum meruit, which has been confirmed under the Uniform Commercial Code as appropriate for determining a reasonable price in an open price term contract.The basis for WellRithms methodology is the most recent publicly available Medicare cost report submitted by hospitals. WellRithms has every publicly available Medicare cost report loaded in its system and has developed a proprietary and comprehensive crosswalk between every individual departmental cost-to-charge ratio and every revenue code that may appear on a bill. Rather than using a single reference rate, WellRithms methodology utilizes all these factors when determining an accurate usual, customary, and reasonable price for a bill.

Question 7

Do you apply the same repricing methodology for all types of services and in all jurisdictions?

Accepted Answer

WellRithms reviews medical bills across all insurance industry lines, including Commercial Health, Worker’s Compensation, Automobile Accident, and Liability. Each insurance line is regulated uniquely and must be considered when reviewing a bill. However, the overall legal principal of quantum meruit is the driving force behind all of our work. All bill review clinical edits are specific to each bill type but are consistent for all jurisdictions and include a physician review of the services to ensure that the bill matches the medical records.

Question 8

What is this quantum meruit that you keep mentioning?

Accepted Answer

Quantum meruit is a Latin phrase meaning what one has earned. In the context of contract law, it means something along the lines of reasonable value of services.

Question 9

What is the turnaround time for WellRithms to review and reprice a medical bill?

Accepted Answer

Most medical bills are reviewed and repriced within 24-48 hours.

Question 10

What is your average savings on a medical bill that is reviewed?

Accepted Answer

Our average savings vary from state to state, by specialty, and by insurance industry. Nationally for all bill types, WellRithms experiences an average to 60% to 80% in savings from the amount billed by providers. This reduction is GUARANTEED.

Question 11

Should a provider disagree with the WellRithms reimbursement amount, does WellRithms negotiate settlements to resolve pricing disputes?

Accepted Answer

WellRithms does not negotiate with providers on any pricing disputes. WellRithms engages with providers to explain the reimbursement methodology that was utilized to determine fair reimbursement. WellRithms expects the provider to offer the same courtesy by supplying a detailed explanation of their dispute with documentation that justifies additional payment. Should a provider substantiate additional justifiable reimbursement by submitting documentation that supports services performed but not paid, WellRithms will review and make sure the provider is paid on all services performed.

Question 12

Does WellRithms pick up all defense costs associated with defending its pricing?  Do you also cover any penalty and interest cost associated with your pricing?  Is there a cap on defense costs per bill, or per customer?

Accepted Answer

For Sustainable Claim Pricing bill review, WellRithms will provide legal defense using WellRithms approved and appointed legal counsel throughout the litigation process to defend our pricing. Should a client decide to choose their own legal counsel, WellRithms will provide legal exhibits and expert witness services only.Under the WellRithms Shield Indemnification service, WellRithms assumes all defense costs (without cap) as well as any penalty, interest, or adverse judgement money owed back to the provider

FREQUENTLY ASKED QUESTIONS

CLASSIFICATION,
EDITS, & AUDIT

SUSTAINABLE CLAIM
& BILL PRICING

SHIELD INDEMNIFICATION

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FREQUENTLY ASKED QUESTIONS

CLASSIFICATION, EDITS, & AUDIT

SUSTAINABLE CLAIM & BILL PRICING

SHIELD INDEMNIFICATION

CLASSIFICATION,
EDITS, & AUDIT

SUSTAINABLE CLAIM
& BILL PRICING