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!).