benefits of using a bill review service julie nauman, executive officer

California Victim Compensation Program

Benefits of Using a Bill Review Service

Julie Nauman, Executive OfficerCalifornia Victim Compensation Program


California Compensation Program• Fiscal Year 2011/2012• Applications received: 53,373• Bills Received: 192, 462• Bill Line Items: 570,447• Payments Made: $70,422,450


Bill Review Service

• Since 1992, CalVCP has contracted with Medical Data Exchange or MDX

• Significant savings through:

o Fee scheduleo Eliminating charges for services billed that

are non incident-related or consistent with the injuries


Medical Fee Schedule

Prior to CalVCP medical fee schedule

•Medical expenses were paid at 100% of billed amount

•Accounted for 40% of CalVCP costs

• Payers typically use some form of fee schedule.

• Unusual for a payer to simply pay all medical bills in full as CalVCP did previously


Establishing Bill Review Service• Staff previously negotiated with hospitals

regarding expenses exceeding $10K

• Provided approx. $400,000 savings per $1.6 million submitted

• Even still, savings represented only a small percentage of medical bills


Fee Schedule

• Depending on solvency, CalVCP used variations of the Medicare Fee schedule to include plus and/or minus 20%

• Current Board approved rate is a flat Medicare rate of payment


Why Use BRS?

• Cost effective

• Technical expertise is needed for complicated rule-based system• Requires updates to tables and interfaces with

licensing boards

• Allows quick turnaround for changes• Contractor prepared to make rate & payment

adjustments to support program


Costs vs. Benefits

• BRS Costs approximately $550,000 annually

• BRS Provides Significant Savings• $1.8 million average annual dollar savings for the

contracted service vs. in-house processing of bills

• Over $337 million in expenses submitted to MDX in FY 11/12; $80 million paid• Net cost savings of nearly $257 million;76%

reduction in bill amount!


Thank You- CalVCP Public Affairs

benefits of using a bill review service julie nauman, executive officer

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