Quality Assurance / Audit Services
Concierge Membership
Conduct line item audit
- Guard against duplicate charges
- Prevent double billing & payments
- Detect erroneous charges
- Negotiate out-of-pocket discounts
- Identify & correct balance billing practices
- Help reduce uncovered medical bills
- Help establish payment plan(s)
- Untangle medical and insurance concerns
- Review out-of-pocket responsibility
- Resolve coverage denials and eligibility problems
- Assure correct application of provider network status
- Assist payers to correctly pay claims or apply benefits
- Resolve coordination of benefits
- Resolve billing errors with providers and/or health plans
- Resolve claims sent to collections
Claims Auditing is a Springboard to Cost Savings!
Most health insurance companies offer a 30% royalty to their members who help reduce health care costs.
- Following a heart attack, patient received 2 stents
- Patient was charged for 200 stents
- Overbilled $465,000
- Hospital charged $13,788 for doctor’s services
- Doctor’s actual charge was $1,266
- Hospitals cannot bill for doctor’s services
- Hospital fraudulently overbilled patient $13,788
- Patient was in the hospital for 4 days following surgery
- Billed for 12 separate medications patient never received
- Overbilled $4,800
- A newborn was charged for private room
- Overbilled $1,500
- Private pay (uninsured) patient was given the wrong bone graph
- Patient requested less expensive bone from a cadaver
- Doctor inserted a more expensive silicone based bone graph
- Overbilled $19,500
- Patient spent 5 days in the hospital following surgery
- Was charged $500 to be applied towards hospital’s foundation
- Charged for $6,500 for medication patient never received
- Overbilled $7000
- Patient had hip replacement surgery
- Patient had Medicare plus supplement insurance
- Expected zero out-of-pocket responsibility
- Patient received a bill for $7,700
- Hospital fraudulently “balanced” billed the patient
- Overbilled $7,700
- A 42 year old was admitted into the hospital for 6 days
- Patient was wrongfully billed for being admitted into the NICU
- Overbilled $6,800
- Patient was admitted into the hospital for pneumonia
- Hospital’s charges included $1,300 for anesthesia and $8,400 for surgery services
- Overbilled $12,000
- Following cancer treatment, a Vietnam Veteran had medical bills totaling $86,894
- We intervined and was able to get his medical bills to $0.00
- Saved this american hero over $86,894
- He was finaly able to retire the next day