WE HAVE A WINNER! (or more??)
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Voting is Open! Choose Your Most-Worthy Lost Benjamins Award Recipient
The second year of the Lost Benjamin Awards brought more examples of egregious overpayments in health care claims. Now it’s time for you to choose the 2023 Lost Benjamin Award WINNER (or loser depending on how you look at it!).
Below are summaries of each nominee with a link to the full story. Who will get your vote? The winner will be announced in February. And we’re gearing up for even more examples of erroneous claims in 2024. Do you have an example of Lost Benjamins? We’d love to hear it! Share your story at hhadmin@healthcarehorizons.com.
SKIP TO VOTING
January: Covid Changes Create Chaos: Lost Benjamins Nominee
The Covid pandemic feels long ago, but the impact is still being seen in healthcare claims. Covid billing requirements often aren’t updated correctly and continue to be paid at higher rates than now accepted. We ensure the new rules are applied when we conduct our audits.
February: Infusion Confusion: Lost Benjamins Nominee
Don’t assume a large bill is correct! While on the surface this claim appeared to be filed correctly, it in fact was reimbursed at a higher than agreed cost for a drug. Our comprehensive audit was able to flag the amount and analyze the validity. Our client has 500,000 reasons to be glad we did!
March: Missed Opportunity: Lost Benjamins Nominee
This tale emphasizes the reason comprehensive audits are superior. Limited to random sampling for this client, we never-the-less found a significant error. Our experts then noticed that the claim error seemed similar to other found claim errors. We realized there was a systemic error. Unfortunately, we couldn’t run a comprehensive audit, so we couldn’t find all lost dollars.
April: Out-of-Network Payments: The Sky is NOT the Limit
Maximum charge policies are in almost every service agreement. However, if audits aren’t performed, overcharges can slip through the cracks. Our test of a payment’s validity reclaimed nearly $100,000 for our client.
May: Reasonable Payments: An Important Distinction
What is reasonable to one person may not be reasonable to another. But this gray area can make it difficult to determine if there has been a billing error. That’s why we have actual experienced people reviewing data claims sets to identify potential errors that might look “normal.”
June: Not All Publicity Is Good Publicity
We spotlight two cases of companies being called out for misallocated medical claims. These situations are, sadly, not isolated incidents. Don’t be a statistic in the news. Help keep your self-funded insurance plans fiscally sound with comprehensive audits.
July: Benefit Errors Cost More Than 7 Million Dollars
Dollars aren’t the only metric for success in an audit. In this case, our audit showed that a software configuration issue was causing claims to be misfiled. And don’t get us wrong, the $7 million in lost dollars was a nice bonus!
August: Seven is a Lucky Number!
Understanding the fine print in service agreements is as important as the actual audits. If we didn’t know that a claim seemed to include a fee outside of agreed upon fee rates, our client would have lost more than half a million dollars!
September: Truth is Stranger Than Fiction
You don’t expect a routine office visit to be billed 62x the amount, but it happened! Thankfully, our client understands the importance of a comprehensive audit that reviews 100% of claims. Without this approach, these “small” claims would add up to “big” lost dollars!
October: Proven Systemic Error
Persistence pays off! We have performed annual audits for a client for numerous years. However, their TPA limits audits to random sampling. Despite knowing there was a repeated error, this year was the first time the error was chosen for review. Once identified, we were able to show the pattern of error and return dollars to our client!
November: Healthcare Transportation Claim from the Twilight Zone
When a 45-mile trip turns into a $455,000 transportation charge, you know you have entered the Twilight Zone. Even stranger was the negotiating our experts had to do to convince the TPA that the claim was incorrect!
December: Drowning in an Overpaid IV Claim
No one wants to receive 250 gallons of IV fluids. And no one REALLY wants to be overcharged for the excessive amount! Thankfully, our audit found the mistake and our client received credit for the overpayment.