Our team combines advanced AI with expert physician oversight to deliver precise medical bill reviews. While our Artificial Intelligence (AI) handles the majority of repricing efficiently, our U.S.-trained physician reviewers step in to address complex clinical billing issues that require specialized expertise. This includes analyzing operative notes, implant usage, and billing codes to ensure accurate and defensible outcomes.

Our physicians review surgical reports, multiple procedures, units of service, and implant or drug charges to validate accuracy and appropriateness. When discrepancies are identified, they adjust the billing codes or deny unsupported line items to reflect accurate reimbursement. Additionally, WellRithms’ reviews include comprehensive DRG validation, ensuring that the documented medical reports align with the billed DRG. When discrepancies arise, the appropriate DRG is substituted, and reimbursement is recalculated accordingly.

Finally, our medical review process extends to air ambulance bills, where our team conducts thorough medical necessity reviews, ensuring every charge aligns with both the medical context and industry standards. Let us know if you’d like further refinements!

Implant reviews are a critical part of ensuring accurate and fair medical billing. At WellRithms, our implant review process is guided by a team of highly skilled physicians, including orthopedic and general surgeons who bring firsthand experience from performing the very procedures they review. This unique expertise allows us to go beyond standard pricing checks to ensure both cost accuracy and proper utilization.

Our implant review process validates which implants were actually used in the procedure and assesses their appropriateness for the patient’s specific needs. Any items found to be unnecessary or not used are excluded from the final reimbursement. By combining a national database of implant acquisition costs with direct collaboration with device manufacturer representatives, we deliver precise, defensible pricing based on a widely accepted cost-plus approach. Our physician-led process ensures transparency and fairness, bringing clarity to a complex aspect of medical billing.

Our physician-led review team provides unparalleled expertise in medical bill analysis. Led by experienced U.S.-trained surgeons, our team brings a deep understanding of medical procedures and coding practices that allows us to identify errors and inconsistencies often missed by standard coding edits. With extensive experience in both clinical practice and medical coding our physicians offer a unique perspective that ensures bills are reviewed with precision and accuracy.

Our approach leverages surgical expertise to thoroughly evaluate complex, multi-procedural bills and implant usage, areas where standard reviews often fall short. Even for non-procedural bills, our physicians’ advanced medical knowledge allows for a level of review that goes beyond surface-level audits. By focusing on accuracy and fairness, we ensure defensible outcomes that benefit all parties involved.