Medical Cost Containment

Cost Containment Services

SFUR defines medical cost containment as the process of leveraging medical and business knowledge to potentially lower the cost of medical bills.

We provide review, assessment and negotiation of medical cost, using a variety of methods which include, Separation of Charges, Coding Validation, Medical Necessity, State & Payer Specific Rules and Reasonable Charge Analysis.

Medical Cost Containment Services

DRG Claims Auditing

DRG Claims Service provides expertise in identifying, correcting, and obtaining verified changes to DRG coding errors. SFUR licenses a customized pre-payment DRG auditing program that flags potential problem claims that are reviewed initially by nurses and if a clinical review is required, physicians perform the full clinical chart review.

SFUR Ensures DRG Claims compliance and integrity with provider-verified audit results with a customized service model for managed care payers.

Our clinical and business leadership brings decades of experience in cost containment in every payer-based and managed care setting.

Medical Bill Review

Medical Cost ContainmentMedical Bill Review Medical Bill Review The competitive landscape for medical bill review is vast and large. There are no barriers of entry in the medical bill review market place. Hundreds of companies offer experienced medical bill analysts and nurse reviewers to find un-bundling of services, and non-compensable charges. These companies can use national provider networks, Usual and…

Reasonable Charge Analysis

Medical Cost ContainmentReasonable Charge Analysis Reasonable Charge Analysis SFUR is routinely retained to provide a usual and customary reasonable charge review (UCR) of charges submitted by the providers. SFUR will review all bills and associated clinical documentation. SFUR will review and compare with standard coding guidelines and customary and reasonable rates according to criteria and methods. Reasonable Charges (billed charges…

Medical Cost Containment Group

Medical Cost ContainmentMedical Cost Containment Management Medical Cost Containment SFUR defines medical cost containment as the process of leveraging medical and business knowledge to potentially lower the cost of medical bills. Our results speak for themselves. Typically, if our payer customers pay a fixed fee for our services (regardless of the savings outcome), they will generate a 400% return on…

Medical Bill Negotiation

Medical cost ContainmentMedical Bill Negotiation Medical Bill Negotiation SFUR has successfully negotiated medical bills on behalf of payers for over 20 years. The utilization of practicing physicians typically with medical coding experience has been the single largest factor in our success with medical bill negotiation. Over 70% of the time, SFUR achieves success through this process. Our fee structure can…

Medicare Secondary Payer Services (MSPS)

Medical Cost ContainmentMedicare Secondary Payer Services (MSPS) Medicare Secondary Payer Services (MSPS) Centers for Medicare and Medicaid Services (CMS) maintains guidelines for Medicare Set Aside (MSA) Workers’ Comp and Liability including updates, submissions, medical cost projections (MCP), life care plans, MCP to MSA conversion, Conditional Payment Identification, Conditional Payment Dispute/Resolution, Final Document Submission, Medicaid Services, Medicaid Dispute/Negotiation, Medicare Check. Social…