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

Lost Benjamins Award: January 2022 Nominee for Most Absurd Healthcare Claim Man Glows After Hundreds of X-Rays on Same Day No, this didn’t really happen. But absurd healthcare claims appear almost everywhere. If this absurd healthcare claim was actually true, this patient would have been out thousands of dollars and been exposed to an extremely … Read more