With the spiraling cost of health care seemingly going unchecked year after year, many companies are groping for ways to reduce their costs.
Some are reducing health-care benefits for their employees, but some are turning to innovative ideas, one being the Medical Review Institute of America, 670 E. 3900 South."MRI, formed 10 years ago, acts as a cost-containment resource for a wide range of medical insurance programs," said Bill Low, president. The company has 550 clients throughout the country including insurance companies, third-party administrators, self-insured companies, labor unions and other organizations that pay medical bills.
When a company receives a doctor bill that might seem excessive, it send the bill to MRI, which then sends it to an experienced, board-certified physician in the same medical specialty to review the claim.
MRI reviews solve the clients' problems by providing documented medical opinions to help them make fair and informed benefit decisions. The savings can be substantial as well.
MRI has 300 consulting doctors who specialize in medical areas ranging from acupuncture to urology. They are paid by the number of minutes they spend reviewing the medical documentation and writing their opinions.
When the claim is submitted to MRI, it is carefully checked for adequate documentation before being sent to the reviewing physician. The physician reviews the file, renders an opinion on the appropriateness of the treatment, checks the medical coding to see if it is correct for the procedure performed and recommends whether the fee is reasonable and customary for the services rendered.
The opinions are sent back to MRI, where they are carefully checked by claims examiners who have extensive medical insurance experience to ensure that all questions have been answered and the terminology and medical codes are correct.
They then convert the reasonable and customary charge recommended by the reviewer to the appropriate amount for the city where the physician treated the patient. The opinion is typed and sent to an editor who makes a final check for accuracy. Credentials of the reviewing physician are included with the opinion that is returned to the client.
Low said that for many surgeries there are global billing codes established by the American Medical Association to specify a number of services that should be included in one "global surgical fee." Some physicians bill for each of the services individually to generate additional income rather than use the global billing code.
This practice is called "medical claim abuse" by the insurance industry and "is one of the reasons medical insurance premiums are increasing so rapidly for all of us," Low said.
MRI has three marketing people on the road at all times trying to interest clients in the company's service. Each client receives a manual designed to help spot abusive claims and determine what documentation is required to review claims properly.
"Surprisingly, many companies are still paying every claim without questioning excessive medical treatments and charges," Low said.
"We lean over backward to provide an objective, unbiased review of the services and fees in each claim we review. The great majority of doctors throughout the country are concerned about rising health-care costs and want to do their part by treating and billing correctly, Low said.
Low received a bachelor's degree in business from Brigham Young University in 1963 and a master's degree in business administration from Harvard University in 1965. He worked for Marriott Corp. as vice president of finance and administration for the Restaurant Group for 20 years and retired in 1987.
He purchased MRI in 1988.