Healthcare Horizons identified an instance for a client in which a surgical implant was billed incorrectly at $777,000 versus $77,000. As the reimbursement was based on a percentage of the charges, the billed charge amount had a significant effect on the final payment, resulting in an overpayment of $300,000. Initially, the claims administrator responded that the claim was correct and that a high-dollar review (second-tier review when claims exceed an established dollar threshold) had already been performed. However, Healthcare Horizons was able to demonstrate a probable billing error based on the type of implant billed; we consequently convinced the claims administrator to follow up with the hospital, which then acknowledged a keying error resulting in the overcharge. The result was an overpayment recovery of $300,000 for our client.
