Truth is Stranger Than Fiction - Healthcare Horizons

In recent months, we noted a record finding for a single claim recovery of over $1.7 million dollars for a client and a systemic error involving thousands of claims totaling over seven million dollars in recovery for a client. We all recognize that news shows focus on big stories rather than daily routine events to grab viewer attention. This month we thought we would show that sometimes it is routine matters that can still result in important news.

A $275 healthcare claim for a routine OB/GYN office visit by a patient is not news. However, when the health insurance company reimburses the physician $17,000 for the office visit – that’s news! We cite this finding as this month’s LBA nomination as evidence that 100% audits of claims are necessary, or such errors will never be discovered.

Even with today’s computer automation, errors still occur in paying routine claims. This is why we refer to our comprehensive audits as our ‘100% difference.’ Self-insured employers should never fail to have 100% comprehensive audits of their healthcare claims payments because third party
administrators (TPAs) will always experience errors in paying medical claims.

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.