After the bills have been audited, cost research can be performed to apply reasonable and customary pricing, utilizing:
- Current Procedural Terminology (CPT) codes for professional services (i.e. physician services, radiology, therapy). Costs found in sources such as Med Fees, National Fee Analyzer, Fair Health
- Healthcare Common Procedure Coding System (HCPCS) for items like supplies, ambulance services, DME. Costs found via phone, internet, Medicare or VA research
- Diagnosis Related Groups (DRG) for hospitalizations. Costs found through American Hospital Directory, VA tables, Medicare and Medicaid tables
Once the bills are totaled, they are compared to the cost research.
Category: Past Medical Bill Review