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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.

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Benefits of Using a Bill Review ServiceJulie Nauman, Executive Officer

California Victim Compensation Program

california 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

bill review service
Bill Review Service
  • Since 1992, CalVCP has contracted with Medical Data Exchange or MDX
    • Significant savings through:
      • Fee schedule
      • Eliminating charges for services billed that are non incident-related or consistent with the injuries
medical fee schedule
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
establishing bill review service
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
fee schedule
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
why use brs
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
costs vs benefits
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!
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Thank You

- CalVCP Public Affairs