Houston, TX – February 16, 2018 – Hopewell Risk Strategies (formerly Moody Review), part of the Hopewell Group family of companies, is proud to announce its recent success in saving over $1.6 million for its client and reinsurance partners for a single, catastrophically ill patient case.
The original billed charges totaled well over $5.7 million across just seven claims. The client asked for assistance in sifting through the details of all charges and to apply our decades proven Medical Bill Review (MBV) product for this patient’s case. Hopewell’s Clinical unit found several inappropriately billed charges. Here are some examples of the savings found:
- The facility billed for airway suctioning the patient when the patient was already in the Intensive Care Unit (ICU). Airway suctioning are routine and inclusive functions for this special care area. A higher level of charges is already expected and allowed for the ICU room costs.
- The facility charged $4,218.00 three times for an arteriography through an existing catheter. During this medical procedure the patient is injected with an imaging dye and x-rays are taken of the arteries or veins to assess or find potential blockages.1 The patient was in the Operating Room on this day and his bill was already allowed the Operating Room (OR) charges, therefore the arteriography charges were considered inclusive of the primary procedure already billed and allowed in the Operating Room charges.
- Another example found was a charge for $986.50 for 1 milligram dose of Alteplase. Alteplase is used to open the arteries and veins and is routinely only given during medical procedures.2 Again, this was flagged as inclusive of the primary procedure already billed through the Operating Room charges.
Hopewell’s Clinical Unit also uncovered another $49,000.00 in charges that were incompletely documented. The patient’s medical records were submitted by the participating facility to justify some of the flagged charges. These flagged charges consisted of incorrectly billed medication dosages and quantities. The facility billed for the Intravenous (IV) fluids, aka “piggybacks.” These are basically the 50ml, 100ml, and 250ml IV bags that are used by the hospital pharmacy to mix medications. The medication charges were not the problem, but the $100 to $250 for each of the piggybacks were. For a similar example; one would not expect the local pharmacy to list and charge separately the powdered medication, the fluid, and their labor time for mixing a prescribed cough syrup. Neither should the hospital pharmacy unbundle or charge separately for the IV fluids when the cost of the medication itself is already being billed. Another big item was the aerosol medication and related charges for the patient’s daily nebulizer use. The facility billed each time for plugging in or hooking up the medicine tubing to the oxygen wall outlet in the room. The function of converting the medication into a mist by mixing in the oxygen so the patient can inhale the medication is inclusive of the special care area charges and these charges were flagged. The charges for the actual aerosol medication were allowed. Inconsistent pricing of items was also seen through this patient’s stay.
Hopewell Risk Strategies completed claim coding reviews, post payment audits, and patient advocacy on behalf of this client. These stages are all included in MBV product itself. All claim reviews took place over nine months and resulted in over $1.9 million dollars in reduced charges. The clarity of reduced charges provided in our MBV reports gave our client the ammunition to settle on the inappropriately billed and incompletely documented charges. The final savings for this client off the reduced charges was slightly over $1.6 million. This was a contracted facility and the client also benefited in additional savings through their contracted discount on the allowed charges. The patient was left with a minimal liability of $900.00 for non-covered convenience items.
“It’s so rewarding to know we’ve not only saved our client millions. We’ve also saved a very ill patient and his family from the added burden of crippling medical debt, “ says Dominga Meyer, Director of Client Services & New Accounts.
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