Infusion Confusion: Lost Benjamins Nominee

Infusion Billing Confusion

Finding the error makes things make sense and saves money

Healthcare Horizons recently saved a self-insured employer over $500,000 related to a drug infusion claim.  The third-party administrator (TPA) paid the claim based upon a percentage of charges from the provider, as it had paid for the infusion service visit.  However, the portion of the claim for the drug administered via infusion should have been reimbursed at 102% of the invoice cost of the drug, as the drug is extremely expensive.

During an audit for the employer, Healthcare Horizons identified the overpayment and informed the TPA. After reviewing all related claim information identified by Healthcare Horizons, the TPA determined a refund of over $500,000 was due to the employer for the overpayment.

This situation is a great example of why a comprehensive claim audit looking at every claim is essential.  This error could easily have been missed in a random sample audit.

Don’t roll the dice when it comes to recovering your healthcare dollars! 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.