For today’s Success Story we will be digging into some inconsistent pricing for just the medications on a large claim totaling $ 274,301.50. In the example below, you will see one of the categories under the global explanation codes we use at Hopewell as a means of reducing costs when there is irregular pricing for the same item.
There were 6 medications that were charged inconsistently across line items for the same quantity. In each case, these were the same dose and strength. The Hopewell expert review team noted these errors and made reductions as a result.
Albumin Human 25% per 50 ml the total amount reduced was $ 4,797.00
The total amount allowed was $ 17,737.50
Cefepime per 500 mg the amount reduced was $ 171.00
The amount allowed was $ 1.910.00
Levofloxacin 500 mg tablet the amount reduced was $ 3.50
The amount allowed was $ 10.50
Levofloxacin 750 mg tablet total amount reduced was $ 2.00
The amount allowed was $ 7.00
Octreotide per 25 mcg total amount reduced $903.00
The amount allowed was $ 314.00
Oxycodone 5 mg tablet total amount reduced was $ 42.00
The amount allowed was $ 77.00
Pantoprazole 40 mg reconstituted 1 each vial total amount reduced $ 291.50
The amount allowed was $ 1,044.00
The total savings in irregular pricing global code was $ 6,209.50, just for medications on this claim.
Below you can see the data sets for just two of the medications and the variations across line items.