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<br />. <br /> <br />. <br /> <br />No. The batch is always retained as a unit. <br /> <br />. Are they separated by billing complexity? <br /> <br />All our auditors have been trained and are experienced in all aspects <br />of bill review coding. regardless of the complexity. Should a <br />medical opinion be necessary to determine the appropriate level of <br />reimbursement. our auditors have access to physicians and nurses on <br />staff at HNC. <br /> <br />8. How are medical/legal bills audited? <br /> <br />Our review of medical-legal bills goes beyond review to the schedule. <br />For bills subject to the Official Medical-Legal Fee Schedule. a copy of <br />the medical-legal report is referred to Michael Lents. Vice President and <br />Cofounder of the Lien Division. Mr. Lents' background includes the <br />training of claims professionals in the defense of medical treatment and <br />medical-legal liens. He has written a comprehensive "Lien Objection <br />List" as well as personally handling all the appeals litigation for the <br />company. He reviews the medical-legal reports to determine if they <br />have met the threshold-criteria defining "medical-legal" as provided in <br />Sections 4620 and 4622 of the Labor Code. When possible. he <br />determines that the reports: 1) have been requested by a "party;" 2) <br />have been procured during the time limitations allowed: 3) are capable <br />of standing as evidence. Should the report fail to meet these basic <br />criteria. our auditor would note the deficiency to alert the claims <br />adjuster that additional information may be needed to make a <br />determination. Our Explanation of Review (EaR) would still report the <br />allowed amount according to the OMLFS. along with the red flag <br />notice. <br /> <br />9. How are PPO reductions applied? <br /> <br />. Are they applied only on amounts below fee schedule? <br /> <br />All bills are initially reconciled to fee schedule. <br />below fee schedule will be applied. <br /> <br />Only PPO reductions <br /> <br />10. Are there any other value-added services? <br /> <br />. Threshold reviews for medical-legal bills and reports. as described <br />above are done at no additional cost. <br /> <br />. Our software has a "Medical Alert" feature. This feature has the <br />ability to identify over-utilization to your specific standards. These <br /> <br />4 <br />