Lost Benajmins Award Nominee: June 2023 In the past, we have presented Lost Benjamins Nominees as stand-alone examples of specific cases we have come across in our audits. This month, we turn to a pair of articles that demonstrate how widespread some of these errors have become across the country in companies we audit (and … Read more

Lost Benajmins Award Nominee: May 2023   After many years of developing medical edits to identify excessive charges for medical professionals, facilities, devices, implants and other medical services, many third-party administrators (TPAs) report very high accuracy in paying claims.  However, Healthcare Horizons continues to find extraordinarily large overpayments that are undetected by TPA’s adjudication software … Read more

Lost Benajmins Award Nominee: April 2023   To help keep healthcare costs in check, most insurance benefits plans have tiered coverage. Each plan defines rates for in-network versus out-of-network non-emergency care. This month’s Lost Benjamins Award explains how an employer would have lost nearly $100,000 from inaccurately paid claims if a comprehensive claims audit had … Read more

Missed Opportunity Recently Healthcare Horizons personnel identified a large overpayment of a medical claim by a client’s third-party administrator (TPA) that was quite surprising.  If you have followed our Lost Benjamin Awards, you know that our finding large overpayments is quite common because we audit 100% of our clients’ medical claims on most engagements.  What … Read more

Infusion Billing Confusion Finding the error makes things make sense and saves money Healthcare Horizons recently saved a self-insured employer over $500,000 related to a drug infusion claim.  The third-party administrator (TPA) paid the claim based upon a percentage of charges from the provider, as it had paid for the infusion service visit.  However, the … Read more

Covid Billing Changes Create Chaos Remember when Covid testing was covered for everyone – and then it wasn’t? As the severity of the Covid-19 pandemic increased the demand for healthcare services and products, every major third-party administrator (TPA), along with self-insured employer clients, modified procedures for COVID-related services, including testing.  These modifications impacted many provider … Read more

**WE HAVE A WINNER! Click here to see who was chosen by voters as the biggest culprit of Lost Benjamins!** We’ve showcased 11 great nominees for our 1st Lost Benjamins Award! Now it’s time to pick the one that was most impressive – or outrageous! Whatever metric you choose, we want to hear from you! … Read more

Earlier this year, Healthcare Horizons reported finding the largest overpayment of a single claim in our history.  The lost Benjamins totaled over $1.5 million dollars arising from the duplicate payment of a single medical claim.  We thought that record overpayment of a single claim would stand for at least a couple of years. We were … Read more

Help Me! Help You! Many surgeries require more than one surgeon. A qualified surgeon assisting during surgery provides an instant second opinion consultation. The assistant surgeon can perform ancillary parts of the operation while the primary surgeon focuses on completing the more complex technical tasks. The usual and customary fee for an assistant surgeon on … Read more

Two is not always better than one There’s an old saying that “two are better than one”.  That may be true when it comes to friends, but it is definitely not true for medical claims.  Even in today’s times with all of the advances in technology, duplicate medical claims still occur and sometimes at an … Read more