December 2022 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Ben Krambeck
CEO
Brad Hansen
VP of Provider Relations
Purchasing Power: The Economics of Caring about Employees
With 2022 coming to a close, we continue to watch the economic winds affecting our customers with concern for 2023. While inflation seems to be heading in the right direction (i.e., November’s 7.1% rate is significantly better than the frightening 9.1% experienced earlier in 2022), the overall impact on our economy cannot be understated. Consider the following changes in just one year:
A gallon of milk is up 31%
A loaf of bread is up 22%
A dozen eggs are up 122%
Rents are up 7.1% nationally, with some urban areas much higher
These kitchen table examples illustrate the almost-universal price increases impacting the budget for most American families, especially the working class. While the underlying causes can be debated, the consensus has emerged that inflation is not the transitory, post-pandemic bubble we were told would soon give way to the strong economy of the pre-pandemic years. Rather, it now appears that inflation is more fundamental, and the Federal Reserve Board is at last fully engaged in addressing the situation with some tough medicine in the form of increased interest rates. To that end, November’s 0.5% increase marked the seventh interest hike in the past twelve months, and though future increases may be less than the increases already experienced this year, the Fed is likely to have more hikes in the coming months.
So, what does this mean for health insurance? Read more...
Audit Spotlight
Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA
Senior Audit Manager
High-Cost Drug Charges are Questioned – Physician Reply is Surprising
In this Claims Audit Spotlight, we focus on the review of two (2) physician claims reported/billed for high dollar drug infusion services performed in an office/clinic setting to a member with the diagnosis of malignant melanoma.
CMS-1500 claims/electronic equivalent (837P) were submitted by different physicians in the same group practice for providing care/treatment in their Missouri clinic location (services reported with place of service (POS) code 11, defined as, Office). 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. Cleveland, OH
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
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