The Problem with Auto-Adjudication

A savvy consumer knows to review charges on their credit card statement before paying the bill. You generally do a quick scan to make sure you weren’t billed for something you didn’t actually buy, or that you didn’t get charged twice for a large purchase.

If you didn’t take the time to review your bill before paying, there’s a good chance you would end up paying for a charge that isn’t legitimate.

Just as a person would review items on their credit card bill before paying, AMPS ensures that each line of a medical bill is scrutinized for legitimacy before the claim is paid, beyond the auto-adjudication that typically occurs when processing claims.

Auto-adjudication is when payers process claims quickly without manually reviewing individual claims. Auto-adjudication relies on software to ensure the accuracy of claims, which improves efficiency and reduces costs. 

Processing claims quickly seems like a good thing…. until you realize that the claims you are paying may contain thousands of dollars worth of errors that go undetected using auto-adjudication.

Auto-adjudication software often does not detect billing errors that a manual review would. AMPS Physician-Led Medical Bill Review ensures that each individual claim over $10,000 is reviewed line-by-line by a board-certified physician.

Board Certified Physicians are in hospitals, operating rooms, and physician offices daily.

They understand exactly what services are being rendered and why. 

Read part 2 of this MBR educational series for examples of hospital billing errors that are often paid without a service like AMPS physician-led medical bill review.