According to estimates, up to 80% of medical claims contain at least one error.
With margins shrinking and more demands on our healthcare system than ever before, healthcare payers are under increasing pressure to do more with less. To successfully meet the needs of their members, healthcare payers must become more efficient than ever before.
With the sheer volume of documentation, billing, and paperwork each claim includes, it’s no wonder that most fraud, waste, and abuse costs make it through the system. These costs constitute up to 10% of total healthcare spending. And that’s why smart healthcare payers are partnering with Alaffia Health to prevent overpayments and ensure payment integrity.
The Situation:
Alaffia Health’s next-generation payment integrity platform recently flagged a claim with billed charges over $750,000. Our team’s deep knowledge of medical billing guidelines combined with our AI driven technology identified this high-cost facility as prone to errors, a significant opportunity to prevent overpayments.
One flag identified was under Revenue code 0360, OR Services. This category is rarely reviewed under high level claim coding edits and unnecessary payments are often made.
Upon review of the itemized billing by one of our expert payment integrity analysts, we found that the provider had charged for duplicate or crossover services that are clearly defined as not separately billable. Charges for daily management and initiation services of Extracorporeal Membrane Oxygenation (ECMO) simply can't be billed on the same day. These crossover charges represented an overcharge of $78,059.96!
Our Results:
The initial claim totaled $776,334.38, including $92,082.93 in operating room service charges (revenue code 0360.)
Alaffia identified overpayments for this claim of $78,059.96 for revenue code 0360 and $12.351.40 for other charges.
Alaffia generated savings for this claim of: $90,411.36
The new charge amount after Alaffia’s review is: $685,917.02
Alaffia Health leverages advanced AI technology to enable top billing and coding experts to conduct focus reviews on charges most prone to errors, generating concrete savings for healthcare payers. Our fusion of computer efficiency with human expertise drives results.
Book a call with Alaffia today and we’ll demonstrate how our technology and team can protect your organization from overpayments and produce immediate and significant results.
Highlights:
- Alaffia Health’s fusion of expertise and technology allows for more targeted reviews and finds more errors, generating more savings.
- Our contingency-based fee structure means you only pay us when we produce true savings.
- Our systems seamlessly integrate with your own to provide a simple turnkey payment integrity solution.
According to estimates, up to 80% of medical claims contain at least one error.
With margins shrinking and more demands on our healthcare system than ever before, healthcare payers are under increasing pressure to do more with less. To successfully meet the needs of their members, healthcare payers must become more efficient than ever before.
With the sheer volume of documentation, billing, and paperwork each claim includes, it’s no wonder that most fraud, waste, and abuse costs make it through the system. These costs constitute up to 10% of total healthcare spending. And that’s why smart healthcare payers are partnering with Alaffia Health to prevent overpayments and ensure payment integrity.
The Situation:
Alaffia Health’s next-generation payment integrity platform recently flagged a claim with billed charges over $750,000. Our team’s deep knowledge of medical billing guidelines combined with our AI driven technology identified this high-cost facility as prone to errors, a significant opportunity to prevent overpayments.
One flag identified was under Revenue code 0360, OR Services. This category is rarely reviewed under high level claim coding edits and unnecessary payments are often made.
Upon review of the itemized billing by one of our expert payment integrity analysts, we found that the provider had charged for duplicate or crossover services that are clearly defined as not separately billable. Charges for daily management and initiation services of Extracorporeal Membrane Oxygenation (ECMO) simply can't be billed on the same day. These crossover charges represented an overcharge of $78,059.96!
Our Results:
The initial claim totaled $776,334.38, including $92,082.93 in operating room service charges (revenue code 0360.)
Alaffia identified overpayments for this claim of $78,059.96 for revenue code 0360 and $12.351.40 for other charges.
Alaffia generated savings for this claim of: $90,411.36
The new charge amount after Alaffia’s review is: $685,917.02
Alaffia Health leverages advanced AI technology to enable top billing and coding experts to conduct focus reviews on charges most prone to errors, generating concrete savings for healthcare payers. Our fusion of computer efficiency with human expertise drives results.
Book a call with Alaffia today and we’ll demonstrate how our technology and team can protect your organization from overpayments and produce immediate and significant results.
Highlights:
- Alaffia Health’s fusion of expertise and technology allows for more targeted reviews and finds more errors, generating more savings.
- Our contingency-based fee structure means you only pay us when we produce true savings.
- Our systems seamlessly integrate with your own to provide a simple turnkey payment integrity solution.