Covid Changes Create Chaos: Lost Benjamins Nominee

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 payment policies, particularly patient cost share for COVID testing and treatment.  As the pandemic waned and demand for services declined, some of those modifications were reversed, thereby reverting policies to their original design.

Healthcare Horizons observed these rapid changes and anticipated that reversing those changes would likely result in unrecognized payment errors to providers. Thus, we enhanced our audit scopes and procedures to identify such payment errors.

In late 2022, Healthcare Horizons audit personnel identified a systemic error from such policy modifications that resulted in the identification of several million dollars in overpayments.  It is an understatement to report that our client was pleased with the identification of this recovery opportunity along with root cause correction confirmation.

Don’t be the test subject for billing policy changes! Make sure you have comprehensive audits in place to find errors just like this one (and save you a LOT of Benjamins!).

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, and recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for the world’s largest self-insured employers, involving all national payers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers.