September 2022 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Bruce Hansen
Executive Vice President
Chicken Little and PHCS
I was asked to write an article expressing our position on the recent news that PHCS would only be allowed alongside HST on RBP business. The answer is so simple, but I didn’t think readers would want another write-up on Pave the Way® or Direct Primary Care, so instead, I’m going to climb onto my high horse and talk about PHCS going away in general. If you are reading this and don’t know about ClaimDOC Pave the Way® and the success it drives, please send me the name of the sales rep you work with as I will personally review their existence on our sales team.
What would I say to the decision makers at Multi Plan about limiting competitors of HST from using PHCS? I would say, “THANK YOU.” ClaimDOC and HST are not really true competitors due to their limited solution and this change hurts everyone except us. HST is sold by brokers who don’t realize they are sending clients to Burger King rather than paying someone to prepare fresh meals in their homes. It may cost a little more upfront. However, if you understand the value and long-term benefit, then it’s an easy decision. Read More...
Audit Spotlight
Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA
Senior Audit Manager
Claim Audit Reveals 720 Minutes of Overbilled Anesthesia Time
In this Claims Audit Spotlight, we focus on identifying and addressing incorrect anesthesia time for anesthesia services being reported/billed on the CMS-1500 claim form/electronic equivalent.
As healthcare costs continue to climb an upward slope, there is an escalated need for closer assessment of healthcare claims to assist in identifying improper medical billing errors and associated improper claim payments.
A hospital in New Jersey billed anesthesia services on behalf of the anesthesia provider on the CMS-1500 claim form/electronic equivalent. The anesthesia CPT codes reported/billed included: CPT code 00918, with modifier AA and CPT code 99140. The place of service code was reported as 22 – hospital outpatient and the diagnosis on the claim was ICD-10-CM code N20.0 – calculus of kidney.
ClaimDOC’s auditor’s eyes questioned the anesthesia time reported/billed on the anesthesiologist’s claim comprising a total of 806 minutes (13 hours, 26 minutes), taking more time to complete anesthesia than it should for the diagnosis code of, kidney stone. 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. Columbus, OH
Practitioner services for the treatment of intraoperative nerve and muscle testing related to spinal surgery
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
Beatriz is patient, persistent, responsive, and professional. She always follows through and if she doesn't have an immediate answer, she'll find it. With Beatriz as my Member Advocate, I am confident she can handle any issue that may arise including a balance bill. Thank you, Beatriz!
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