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

A Tale of Two Audits Medical claims audits are not created equal! Currently, two distinct types of medical claims audits are conducted to find errors in self-insured paid medical claims. Using the wrong audit can cost a company thousands of dollars! A random sample audit uses an approach where SOFTWARE randomly selects a few hundred … Read more

$7000 per mile. That’s an absurd ambulance healthcare claim! We often talk about the many billing issues that ambulance services encounter. In fact, it’s a frequent enough occurrence that we have services solely focused on our expertise in auditing these charges. So, it’s no surprise that we have a Lost Benjamin Award nominee highlighting this … Read more

A Good Night’s Sleep is Worth How Much? It’s no secret we all feel better after a good night’s sleep. Unfortunately, according to the American Sleep Association, more than 50 million US adults have a sleep disorder. Sleep disorders are defined as problems with the quality, timing, and amount of sleep, which result in daytime … Read more

Lip Stitches and a Bleeding Bill INJURY:           Cut lip (diagnosis code: S01.511A ”laceration without foreign body of lip, initial encounter”) TREATMENT: Suture of lip (aka lip stitches) COST:                  Facility charge $1900; Physician $25,000 WAIT, WHAT?? Are we missing something here? For comparison purposes, … Read more

COVID CASE OVERLOAD In an example of why two sets of eyes are always better than one, we recently reviewed a series of claims that a company’s TPA flagged as being incorrectly billed. However, when we reviewed the data for the entire audit period, we found a systemic problem. MORE THAN 22,000 Covid-19 claims were … Read more

Lost Benjamins Brought in From the Cold You have probably had someone in the past give you the cold shoulder treatment, but you would not have wanted to get the cold treatment that the patient in this month’s absurd healthcare claims example received.  Fortunately for this patient, the only abnormal occurrence he received after his … Read more

Lost Benjamins Award: February 2022 Nominee for Most Absurd Healthcare Claim       Not counting some kinds of skin cancer, colorectal cancer is the third most common cancer in men and women. It is the third leading cause of cancer-related deaths in the United States. Colonoscopies help identify and remove polyps that can turn … Read more