AUDIT RESULTS

What kind of payment errors do we find in our audits? The following examples are from actual audits we have recently conducted:

  • A hospital claim of $245,259 was paid in full by the Carrier. The claim should have been discounted via a per diem rate network pricing contract. We recovered $159,585 for the employer.
  • A claim for inpatient rehab was not authorized and should have been denied. The Carrier paid the claim without question. We recovered $22,378.53 for our client.
  • An employer’s plan excluded coverage for gastric bypass procedures, but the Carrier paid three such claims in full. As a result of the audit, the Carrier agreed to reimburse the employer for the full amount on the claims.
  • A Carrier paid a hospital claim for $18,256, even though the claim form clearly showed Medicare as the patient’s primary coverage. We had the provider re-file the claim with Medicare and recovered $17,416 for the employer.

 

Testimonial

“We have introduced MedReview to many of our clients. The experience
has been one of value added for us. Not only do our clients enjoy the
recovery of overpaid monies but they also realize that the audit process
helps in the overall evaluation of the Plan administrator.”

Lawrence Kirshner; Executive VP; Frenkel Benefits LLC

Let’s work together

A healthcare plan audit program
to safeguard your plan assets 
is a Best Practice