How Center of Excellence (COE) Programs Outperform Bill Review in Controlling Healthcare Cost:
As medical costs continue to rise in both workers’ compensation and group health, insurers are increasingly turning to cost-containment solutions like medical bill review. While bill review helps ensure compliance and reduces overbilling, it is often a reactive approach—addressing costs only after care has been delivered. In contrast, BICMD’s Center of Excellence (COE) program can offer a proactive strategy that improves outcomes and controls healthcare spending earlier in the care continuum. In this blog, we will explore how BICMD’s COE program delivers comparable if not greater value than traditional bill review by preventing unnecessary or low-quality treatments before they occur.
What is Bill Review and why do insurance carriers use it?
For insurance companies, medical bill review is a corner stone tool for post-service cost containment. This foundational tool audits aims to detect fraud, ensure compliance and flag overcharges or coding errors in the billing. Bill review is effective, but it identifies waste after the fact. Bill review lacks the ability to influence treatment decisions at the point of care. This reactive approach limits the payor’s impact on reducing inappropriate utilization while optimizing clinical and financial outcomes.
BICMD’s COE (Center of Excellence) Model:
At BICMD, our Center of Excellence (COE) program has a network of rigorously vetted surgeons and facilities that provide high-quality care for complex procedures. Our providers specialize in delivering high-quality care under a bundled payment model that promotes cost transparency and predictability.
Unlike traditional bill review, which is reactive in nature, BICMD’s COE model is proactive. Every case undergoes a clinical review before surgery to confirm medical necessity and to align treatment with evidence-based guidelines. BICMD helps direct patients to providers who follow standardized, outcome-driven protocols. Our COE helps prevent unnecessary procedures, reduce complications, and ensure better long-term outcomes while containing costs.
| Function | Bill Review | COE Program |
|---|---|---|
| Cost Containment | Post-service Fee Reduction | Upfront Price Transparency and Bundling |
| Quality Assurance | Code Auditing and Medical Necessity | Surgeon/Facility Vetting and Outcome Data |
| Compliance | Statutory Fee Adherence | Episode Adherence to Evidence-Based Care |
| Fraud / Waste Control | Flag Unbundling, Upcoding | Prevents Low-Value or Unnecessary Surgery |
| Data Analytics | CPT-level Data | Patient Level Outcomes and Value Tracking |
Real-World Financial Impact of COE for Claims Cost Control:
Center of Excellence (COE) programs offer a powerful strategy for reducing healthcare costs by minimizing surgical complications, avoiding unnecessary re-operations, and accelerating recovery times. Our COE program facilitates quicker return-to-work timelines and lowers total injury costs by standardizing care and guiding patients to high-performing providers. In contrast, bill review focuses solely on post-service claims accuracy. Bill Review also lacks the ability to influence treatment decisions, limiting the potential to drive long-term, system-wide savings.
What is the value of BICMD’s COE program for Payors and Employers?
BICMD’s COE program goes beyond traditional cost-containment methods to deliver comprehensive value across clinical, financial, and operational metrics. By shifting cost control earlier in the care continuum, BICMD’s COE offers:
- Predictable, bundled pricing: Transparent pricing, given upfront and reduced billing variability with fewer post-service disputes.
- Improved patient experience: Access to the top 1% of board-certified specialists who offer quality-focused care.
- Faster return-to-work outcomes: We optimize care plans to minimize complications and recovery time
- Lower risk of disability: We offer clear, evidence-based treatments that reduce disability and appeals.
- Proactive cost management: We address medical necessity, age of injury, and treatment quality before services are rendered.
Strengthen Cost Containment Using BICMD’s COE Program:
While medical bill review is a necessary component of any payer’s cost-containment strategy, it alone cannot address the root causes of escalating healthcare expenses. BICMD’s Center of Excellence (COE) program provides a proactive, upstream solution that drives better outcomes by aligning clinical quality with cost efficiency. Integrating our COE program with traditional bill review, payors and employers can achieve a more comprehensive, strategic approach to medical cost management. Contact BICMD today and let us show you how to improve outcomes, reduce unnecessary procedures and gain predictable, long-term savings.
