Errors happen. People make mistakes. Claims payment errors cost self-insured employers hundreds of thousands of dollars each year, and while we may not have X-ray vision, we can spot errors from a mile away.
Healthcare Horizons comes to the rescue of our clients by going beyond the identification of payment errors to find root cause issues that often prove to be systemic. For example, we recently performed an audit where fragmented billing resulted in full fee payments of secondary procedures.
When multiple surgical procedures are performed in the same session, it is industry standard to allow payment of the primary procedure at the full fee schedule and any secondary procedures at reduced rates (typically 50% of the full fee). Fragmented billing occurs when providers submit multiple bills or claims for the same session that cause multiple procedure reductions to be missed. Our audit finding determined that appropriate systems and procedures were not in place to combine multiple claim submissions. The carrier is now making system enhancements to correct this deficiency, and Healthcare Horizons was able to help the client recover several thousand dollars in overpaid claims.
To find systemic errors like this, we recommend regular audits to ensure healthcare claims are being paid accurately. In addition, Healthcare Horizons can negotiate high-dollar out-of-network rates (such as air ambulance) to help self-insured employers contain costs and prevent catastrophic balance billing to their employees.
The Difference is in Knowing.
To learn more about our approach to healthcare claims auditing or out-of-network provider fee negotiation services, visit Healthcare Horizons or reach out to us at hhadmin@healthcarehorizons.com.
We would love to meet you in person, so be sure to stop by Booth 825 at the SHRM20 Annual Conference and Exposition in San Diego, June 28 – July 1. We can chat while you have your portrait drawn by California caricature artist, Julia Kelly.
Randy King is president of Healthcare Horizons Consulting Group, Inc. – performing healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.