Medical Bill Review & Nurse Consulting

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We help businesses, attorneys, and insurance claims adjusters understand complex medical records and billing information.

Our team works where medicine, insurance, business, and litigation intersect. We leverage our background in healthcare and insurance to evaluate personal injury claims for risk managers, casualty adjusters, and legal counsel.

Our legal nurse consultants and medical billing experts are retained to:
  • Analyze medical records to evaluate relevance to expected injuries with the associated event
  • Assist with Medicare set-asides
  • Confirm that charges were reasonable, relevant, and reflective of the level of care rendered
  • Generate medical chronologies
  • Provide life care planning and medical needs assessments
  • Verify that medication, equipment, diagnostic testing, and services billed were received

We help clients navigate the surgical, pediatric, orthopedic, trauma, and other medical issues entwined in most medical records. Our Registered Nurses have extensive experience with intensive care, trauma, burns, orthopedics, neurosurgery, general and plastic surgery, rehabilitation services, and bill audits.

Medical Bill Audits & Review

Bills are analyzed against usual and customary geographical databases and compared to pricing with other payment or payer sources, helping to define what a reasonable reimbursement or charge is. Charges can also be compared to Medicare allowances for specific services.

We verify that the claimant received medication, equipment, diagnostic testing and services as billed, alerting clients of red flags such as billing for services not rendered or for services performed by a lesser qualified person, mispresenting procedures performed to obtain payment for non-covered services, and billing for a more costly service than the one actually performed. Additionally, when needed or requested, we can provide court-qualified medical billing experts to deliver expert witness testimony and litigation support.

Life Care Planning & Medical Needs Assessments

Our team helps clients improve reserve setting, cost projections, and claims service for catastrophic injuries requiring ongoing care and medical treatment.

Medicare Set-Asides

We help clients determine appropriate set-aside amounts for future medical costs in worker’s compensation and third-party claims.

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