RMS
SR M R
Special Risk Marketing Services LLC
The Facts
Bill Review is a line item clinical intensive analysis designed to maximize claims savings and protect clients
from liabilities that exceed their contractual obligations.
Examples of Such Situations Are:
o Charges that exceed usual and o Erroneously billed charges.
customary guidelines. o Non-medically necessary
o Over-utilization expenses. services/supplies.
MBI Employs Extensive Analysis Scrutinizing:
o Claim coding validation. o Accuracy and appropriateness of care
o Unbundling. delivery.
o Diagnosis correlation. o Case Management Utilization.
o Trigger evaluation. o Treatment frequency.
o Certain chronic disease diagnosis. o Usual and Customary Reimbursement.
o Ration of Drugs/Supplies to Charges. o Average Wholesale Pricing.
o Durable Medical Equipment. o Dosage Dispensation.
o Disguised Cosmetic Surgery.
Claim Type Criteria:
o Inpatient Facility claims over $10,000 o High ratio of respiratory charges.
o Outpatient Facility claims over $5,000 o Long Intensive Care admissions.
o High ratio of drugs/supply charges o Intensive Care with Direct Home
Discharge.
o Transplants and Implants.
Recurring Medical Care for:
Dialysis, Chemotherapy, RX Therapy, Infusion Care, Home Health Care, Physical Therapy, Occupational
Therapy, and Speech Therapy.
Modern Benefits, Inc. is committed to creating favorable outcomes for all parties involved with particular
emphasis on customer service. Payors will enjoy savings that exceed industry standards, providers will
benefit from prompt and accurate payment and patients will be recipients of lower out-of-pocket expenses.
MBI is a growing and diversified firm located in Rockville, Maryland. The company prorices technology
enabled fully integrated delivery systems of general and specialty membership programs. Their audience is
comprised of direct marketing companies, Third Party Administrators (TPAs), employer grojps,
brokers/consultants, and consumers seeking custom solutions.
Contact: TKeevers@verizon.net to find out how you can provide this valuable benefit
to your Clients and members!