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What is cost research methodology?

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.