benefits of using a bill review service julie nauman, executive officer
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Benefits of Using a Bill Review Service Julie Nauman, Executive Officer California 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. - PowerPoint PPT PresentationTRANSCRIPT
California Victim Compensation Program
Benefits of Using a Bill Review Service
Julie Nauman, Executive OfficerCalifornia Victim Compensation Program
California 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
California Victim Compensation Program
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
California Victim Compensation Program
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
California Victim Compensation Program
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
California Victim Compensation Program
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
California Victim Compensation Program
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
California Victim Compensation 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!
California Victim Compensation Program
Thank You- CalVCP Public Affairs