May 2022 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Amy Pellegrin, J.D.
Senior Vice President and Chief Legal Officer
Welcome to the Party
Transparency legislation has created a new wave of data-driven companies, resources, and information that have stakeholders in the industry drooling over access to this once-secretive, coveted information. The conversations resulting from this information are exciting: employers, brokers, and healthcare providers alike are demanding change, identifying the need for fair and cost-based pricing, and discussing solutions to reach that end. Here at ClaimDOC, we are excited too, and we welcome you to the party.
Since its inception, ClaimDOC’s approach to the market has included a multi-factored approach ensuring we are meeting our fiduciary obligations of being true stewards of plan assets while still working with healthcare providers to ensure access to quality care. We have used hospital cost data to determine claims reimbursement; we have analyzed price information to ensure our clients are paying an appropriate amount, and we research alternative options to sharpen competition and increase choices to play a part in increasing the consumerism in patient care. Read More...
Audit Spotlight
Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA
Senior Audit Manager
Significant Laboratory Test Charges for Controlled Substance Monitoring and Drugs of Abuse
In this Claims Audit Spotlight, we focus on charges for laboratory services related to testing for controlled substance abuse monitoring and drugs of abuse.
Drug testing is used as a diagnostic and therapeutic tool for the clinical care and monitoring of an individual who is undergoing treatment for addiction.
What Accounts for Substantial Differences in Charges for Laboratory Drug Testing?
Charges for laboratory drug testing depend on the entity performing the test, the location where drug testing is performed, the specific CPT/HCPCS procedure code(s) reported/billed, actual drug testing costs, the related markups for the drug tests and other factors.
Case Example
In the case example below, an independent laboratory located in Florida billed three separate claims for two (2) drug tests on three dates of service, April 2, 4 and 6, 2022 as follows: Read more...
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
1. Hazel Park, MI
Outpatient clinic dialysis services for the treatment of end-stage renal disease
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
Austin is the best Member Advocate! I had a bill that the hospital failed to process correctly. I called Austin and he took care of everything. He worked with the hospital on my behalf, saving me hours on the phone. Couldn't have done it without him.
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ClaimDOC, 3200 Westown Parkway, West Des Moines, IA 50266, 1-888-330-7295
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