Billing Error Review
NBAS received an in-network claim for a 17 year old male with a diagnosis of gastritis and billed charges totaling $690,097.96. The patient was admitted to a Virginia facility and was in-patient for 21 days. An NBAS Billing Error Review identified 53 line item charges for a compound solution billed at $4,035.00 per unit. After questioning the hospital’s pharmacy department regarding the charge, it was discovered that a computer error had occurred and the solution should have only been billed at $135.00 per unit. NBAS’s Billing Error Review produced a total savings of $202,800.00 for the client.
Reasonable & Customary Review
A 55 year old male patient was receiving ongoing dialysis treatment from a well-known national dialysis clinic chain. In any given month, the total billed charges were approximately $25,000.00. Consistent pre-screen results showed an estimated Reasonable & Customary savings of 50-55% due to inflated pharmaceutical charges. Upon completing a Reasonable & Customary Review, NBAS found $13,495.36 in pharmaceutical charges exceeding 200% of the Average Wholesale Price (AWP) in one month. The client paid the claim in accordance with the audit findings and saved 54.9% off billed charges as a result.
Medical Record Review
NBAS received an in-network claim for a 45 year old male with a diagnosis of an intra-spinal abscess and billed charges totaling $1,677,235.10. The patient was admitted to a Mississippi facility and was in-patient for five months. Upon reviewing the medical records, NBAS identified unbundled charges of $215,000.00, pharmacy charges of $88,000.00 for medications that were not documented in the medical records, and other charges of $39,000.00 for items that were not supported by the medical records or physician’s orders. NBAS’s Medical Record Review produced a total savings of $343,000.00 for the client.