70% Total Savings Reduction on a routine PPO claim with a 20% Discount

As part of the routine notification screening process, review all network and non-network claims that have questionable billing items.

Billed-$89,000

PPO-20%

Dx: Cardiac Arrest

Bill Summary: patient expired during a 23-hour observation stay.  Result: Provider admitted to billing error of $80,000 on the “MISC” and re-billed.  The new charge was $8,900.

Savings: 70% despite an average PPO discount of 20%.