Proactive Cardiac Transplant Management

Aggressively followed clinical course of the transplant candidate during the hospital stay.

Intervention: After careful review of the clinical information and benefit limitation, noted that patient received non-FDA approved device.  Worked with TPA on the claim review.  In addition, re-negotiated the transplant contract thru a transplant network.

Result: Billed charges-$1,200,000. 

Final paid amount: $450,000. 

Savings: $750,000.