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 cryotherapy was a hefty medical bill.
Cryotherapy Deep Freeze
This particular patient visited his dermatologist in order to have a few cryotherapy procedures performed on one of his extremities. Usually, there would be fewer than four or five of these procedures performed in the same area of the body at one time. However, in this case, the provider submitted a claim for more than 50 cryotherapy procedures. According to the claim, the procedures were all performed on the same patient, on the same extremity, on the same day. Talk about extreme frostbite! This much cryotherapy on one body part would remove far more than the abnormal cells!
It goes without saying that not all of these procedures were conducted, but the claim submitted clearly was not logically assessed by a human (at least we hope not!). The processed amount exceeded $5,000. Thankfully a comprehensive claims audit caught the error and the overcharge was corrected. And, most importantly, the patient still has a healthy extremity.
Do you have an example of an Absurd Healthcare Claim?
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:
- 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:
- identifying excessive out-of-pocket expenses and returning overpayments
- protecting any lifetime maximum payout that may be in place
Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, 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 some of 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.