Medical Services

Medical Services

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Our physicians represent every specialization of the medical community. Routinely they review medical records for the purpose of determining whether the services for which the claims are submitted are reasonable, appropriate and medically necessary.

The medical opinions expressed by our consultants depend on the documentation provided by the treating physician. Each treating physician is required to document the elements of treatment given for the diagnosis.

Where the claimant received treatment is irrelevant to this portion of our handling, as medically prudent treatment is the same throughout the medical community. We encourage submission of complete medical records on each claim we review.

Physician Peer Review consists of medical necessity, causation and documented charges. Usual and Customary variances are completed by inside personnel using CPT fee guidelines.

Peer Review Services

Physician Medical Review

All medical reviews include a summary of the case and Expert’s opinions and recommendations. The report also includes a breakdown of the billing by; provider, medical necessity, causation, undocumented charges and usual & customary. All questions, concerns and comments are addressed when written on the request form under special instructions.

Chiropractic Reviews

Price varies between $1,200 and $1,500+; based on the size of the file the expert has to review and complication level.

MD Reviews

Price varies between $1,500 and $3,000+; based on the size of the file the expert has to review and complication level.

Medical Opinion Only (no bills)

Price varies between $1,500 and $3,500+. Physician reviews the medical records for care and treatment of the claimant then gives an opinion and answers any specific questions when requested. Actual billing is not reviewed or addressed.

Designation Only

If you have an expert designation deadline but do not have all of the records, we have authority from numerous experts to designate them ahead of time. You must notify NAC prior to designating one of our experts. If we receive the case, the designation fee is waived. If the case settles with no peer review, the fee is $150.

Film Reviews

Complete radiological review of films with detailed report: $500 per MRI /CT study. Plain film x-rays are $150 per study. A cost affidavit can be produced for an additional fee.

Jumbo Case

When billing total is more than $50,000 and/or there are voluminous records, our costs will vary. Also; in some instances, we will not know expert’s fees until the review is completed. Whenever possible, we will send a notification when the invoice (or 2 invoices, doctor and NAC) will exceed $3,000. When requested, pre-approval from the requester will be obtained before handling.

Reopens

$750 - $1,000 if:

a) The original report is less than eight (8) months old.
b) The additional bills are less than $3,000.
c) Additional documents do not exceed 300 pages

Files that are over 8 months old, over $3,000 in additional billing or exceed 300 additional pages of records will be considered a full peer review and will be charged at normal pricing.

Line by Line CPT Coding Bill Audits


IN HOUSE – Line By Line Bill Audit (Usual & Customary)

A physician does NOT review the bills or records for medical necessity or length of treatment. Charges are reviewed to determine if they are in line with current National Fee Guidelines. (Usual and Customary variances are completed by inside personnel using CPT fee guidelines) Each provider = $150; billing over $25,000 on any 1 provider may incur an additional fee. COST AFFIDAVITS ARE NOT AVAILABLE WITH THIS SERVICE. A BILLING SPECIALIST OR RN MUST BE UTILIZED.

Billing Specialist/RN Line By Line Bill Audit (Usual & Customary):

A billing specialist or RN reviews the records and bills to determine if they are in line with current National Fee Guidelines. 1-6 lines(codes) = $225 per provider; 7 - 50 lines = $350; 51+ lines(codes) = $525 per provider. Cost affidavits can be produced for $250 each provider by the Billing Specialists or RN.

IME Services

Independent Medical Exam (IME)

An independent physician will examine the claimant. The physician will be based on the specialty you indicate under special instructions on the front of this form. $995 + expert fee

Combo

Physician Peer Review and IME performed by the same physician with two separate reports. $2,250 + expert fee

Nurse Reviews

Comprehensive Nurse Review

A Nurse summarizes the file identifying any billing errors, obsolete codes, unusual codes and/or unrelated codes. This report gives the claims professional a basis by which to negotiate and settle their claim without the need for litigation. This report makes recommendations per the Official Disability Guidelines. $500 flat fee.

Miscellaneous Services

Record Retrieval

$39 per hour plus any any fees charged by the providers.

Research Fee

A fee of $90.00 per hour will be charged on any case wherein we are asked to locate/retain a physician in a particular area or State that we do not have. Fee will be waived if case received to work.

Copy Fee

Any case with records over 2” in height (or 500 pages.) will be charged a copy fee of $.25 per page.

Cancellation Policy

If NAC receives an assignment, selects an expert and prints the records, there will be a minimum $240 cancellation fee.

 

Please note: Our physicians are under contract and are required to testify on behalf of their handling of any report if requested. We require that all communication regarding deposition or testimony in conjunction with cases be coordinated through North American Consultants for control purposes. Please contact: Legal@NorthAmericanConsultants.com

 

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