Imagine if you will, an employee has surgery for a freak chainsaw accident. Assisting in the patient’s care are a masked surgeon, an anesthesiologist with a large wart on the nose, a post-op nurse (who happens to always have a broom with her) and administrative staff who appear to have dead eyes. The total cost for the procedure is $100,000. But unbeknownst to you, your third-party administrator paid out a total of $150,000. That’s $50,000 of overpayment lost to you and your company’s bottom line.
This story, while (possibly) fictional, is based on real-life billing errors. Healthcare reimbursement overpayment is a real and growing problem. In fact, according to a 2019 study by Humana, overpayments were a significant contributor toward the estimated $265 billion in wasted healthcare spending.
With a growing number of medical claims each year, there quite simply will be more mistakes. The 1-3% error rate doesn’t change so the numbers rise. There are several factors that can contribute to healthcare reimbursement overpayments. The type of mistakes include:
- Coding errors: Coding errors can occur when healthcare providers use the wrong codes to bill for services. This can lead to overpayments for services that were not actually provided or for services that were provided at a lower level than what was billed.
- Duplicate billing: Duplicate billing occurs when healthcare providers bill for the same service multiple times. This can happen accidentally or intentionally.
- Fraud: Fraud is another leading cause of healthcare reimbursement overpayments. Fraud can involve healthcare providers billing for services that were never provided, falsifying medical records or upcoding services.
Turn an Overpayment from a Trick to a Treat
Medical claim overpayments can dress up as something innocent and if you don’t know what to look for, you won’t find the mistake. Fortunately, we are experts at unmasking the imposters. Our comprehensive review process means that we find more errors than the random sample method. Random may be okay when reaching in the candy bowl, but it means you could be missing a big reimbursement when reviewing your healthcare claim payouts! Don’t you want to find that missing $50,000?
Halloween is a time for fun and spooks, but it’s also a time to uncover the mistakes in your healthcare claims payments and make plans to try and keep them from happening again. Let us take the scary out of your self-funded health plan. We can help you with your audits and review your annual agreements to help protect your investment.