“Winner” of Our Lost Benjamins Award and how to avoid being on the list

The Winner is – Clients that Found Benjamins!

Our new biggest loser competition – the Lost Benjamins Award – hit the ground running in 2022. Drum roll please…our 2022 winner is Man Glows After Hundreds of X-Rays on Same Day. It seems everyone agrees that not noticing a bill for 850 x-rays on the same knee on the same day is a mistake that shouldn’t happen. Fortunately, our comprehensive audit didn’t miss it and we were able to recover thousands of dollars for our client.

A close second was our largest recovery to date – a $1.7 million error! This was a classic case of failed checks and balances. Human error caused the mistake, but the backup – a review of the processed claim by an experienced employee – missed the overcharge. Thankfully, we didn’t! That number of Benjamins can help fund a lot of other worthy employee initiatives!

Payment Integrity Makes Sure Your Company Isn’t Our Next Winner

Most of the errors found in claims datasets are not intentional, but the rapidly changing healthcare system often makes accuracy a challenge for today’s workforce.

As staffing shortages impact every level of healthcare, including billing staff, medical coders and data entry specialists, steps need to be taken to minimize mistakes in the medical claims process. A payment integrity plan helps identify areas of weakness, correct problems and reduce the risk of future errors.

The payment integrity plan should encompass every phase of the billing cycle. This includes a review at the entry point to ensure common sense billing. Our Lost Benjamin Award winner above is the perfect illustration of the importance of starting the claim correctly! The next stage checks to be sure there isn’t fraud and to confirm medical necessity. Finally, the system should include an end-stage comprehensive review of claims. This is the last stop for finding errors and recovering overspent dollars.

Comprehensive Reviews are a Win-Win

Unfortunately, these winners are only a handful of the types of mistakes our audits catch on a regular basis. Are your audits finding these costly errors? If you are unsure, contact us for an assessment of your audit process. Our comprehensive reviews help control medical costs – and that’s a win for both the self-insured employer and their employees!

Thank you to everyone that submitted entries and voted in our first annual LBA contest. Don’t forget to check back each month to read about our latest Lost Benjamins nominees for 2023!

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.