General Liability

As with any negotiation, knowledge is power. When dealing with General Liability (GL) claims, providers and hospitals start the process in a position of strength. They know they are not under an obligation to reduce your medical liability, making the negotiation process a tedious challenge. If your position does not change, the negotiation will be doomed from the beginning.

IMS provides comprehensive general liability bill review services. At IMS, we understand the challenges of handling GL claims and will customize a cost containment program to meet our client’s needs and support their unique workflow. The IMS GL Review Program changes your position to one filled with information, negotiation experience, and strength to maximize your savings. We offer a Usual and Customary (U&C) program to help your own negotiation efforts and a Comprehensive program option where IMS takes ownership of the negotiation.

U&C GL Review Program

Our U&C option arms you with an Explanation of Review (EOR) that identifies U&C reimbursement values to help you bolster your own negotiation effort from a position of knowledge.

IMS begins our review by scrutinizing every bill for errors, duplicate charges, over billings, excessive CPT code charges, procedures that should be bundled, errors, fraud, and more. Our technical auditors have years of experience in identifying billing inconsistencies allowing them to immediately reduce the medical charges before the negotiation process starts.

After the bill has been cleansed of billing abnormalities, we identify reimbursement recommendations through our U&C analysis. We utilize the following databases when conducting a U&C review: U & C database, Medicare reimbursement methodologies, Relative Values for Physicians, NCCI edits, workers’ compensation case law, CPT Professional Edition, providers’ cost invoices, usual and customary standards for the providers demographic regions.

Comprehensive Review Program

Our comprehensive program takes ownership of the negotiation process by reviewing each bill to U&C standards, drafting a negotiation strategy based on supporting data and previous review history, exploring PPO opportunities, data analytics, and out-of-network contracts to take the bill to a full and final signed agreement by the provider.

As well as generating great bill review savings, IMS’ PPO partners offer widespread PPO coverage and substantial PPO discounts on general liability bills.

In addition, as a software development company, IMS built a specialized database that stores provider billing information to assist with future reviews and negotiations. Examples include but are not limited to:

  • notes on prior negotiations
  • contacts and personnel
  • previous accepted payments
  • billing patterns
  • provider affiliations

Most companies charge a higher fee for specialty review services than IMS due to the need to access “out of network” databases. They are at the mercy of these third party vendors and as a result, have no way of updating or controlling the quality of the data. IMS is proud of maintaining such information in house to provide the highest level of accuracy.

IMS’ bill negotiation services consistently deliver superior outcomes. Our expert negotiators conduct usual and customary reviews and take into consideration the provider’s geographic location, credentials, and prior billing and payment history. Every negotiation is documented and signed by the provider to prevent future liens.