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 into cancer.
Five Days of Prep for Five Colonoscopies? No Thank You
Millions of colonoscopies are performed every year on Americans across the country. However, consider the case of one patient who supposedly had five colonoscopies performed on him on the same day! That’s correct. The provider submitted charges for five separate colonoscopies that were conducted on the same patient on the same day. If you have ever undergone the preparation on the day before a colonoscopy, you surely would not want to do this again every day for five days much less be able to undertake five of these procedures on the same day!
Failure to Identify
This claim was clearly a deviation of certain medical edits that should have been identified for further review by the TPA. In this instance, the provider billed for an incorrect number of colonoscopies and the TPA failed to identify this claim as an error at the time of billing. Fortunately, we discovered the erroneous claim during a claims audit and requested that the TPA adjust the claim. The end result was that the TPA agreed with the error, adjusted the claim from the provider, and recovered the overpayment for thousands of dollars for our client. We don’t know this for certain, but we believe that the patient was probably also ecstatic that he was not the recipient of five colonoscopies on that day!
For more information on colorectal disease, visit the CDC website.
Do you have an example of a Healthcare Claim Absurdity?
We know our audits catch a lot of inaccurate claims. Fortunately, seeing ones that defy the imagination are rare. However, there are many, many overpayments costing patients and companies thousands of dollars. We want to hear your best example! Who knows? We may feature your story as one of our monthly nominees! Send your best story to hhadmin@healthcarehorizons.com with the Subject Line: Lost Benjamins Award. If we use yours, we’ll be sure to give you the recognition you deserve for shining a light on medical overpayments!
Healthcare Claims Audits Protect Companies & Employees
Large self-funded companies hire TPAs to process thousands of healthcare claims on their behalf. Mistakes happen. Sometimes the errors are a one-time event. Other times there is a systemic issue that causes the same error to occur over and over. Comprehensive audits evaluate your paid medical claims and identify errors. You have to find the errors before you can recover the dollars!
Finding errors benefits companies by:
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- returning dollars back to the company’s bottom line
- holding increasing premiums in check
- allowing better plan options as an employee benefit
Finding errors benefits employees by:
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- identifying excessive out-of-pocket expenses and returning overpayments
- protecting any lifetime maximum payout that may be in place