CASE STUDIES & SUCCESS STORIES
Dialysis Coding Overcharges - $2,002,145
Our medical claims review uncovered improper use of an unlisted procedure code by a nationwide dialysis provider, leading to charges far above contracted rates. By identifying and correcting this misuse, the team recovered $2,002,145, ensuring accurate reimbursement and preventing future inflated billing.
Anesthesia Rate Overpayments - $1,804,742
During a review of anesthesia claims across several regional providers, analysts discovered that reimbursement rates were being applied far above market standards. Through careful contract comparison and financial analysis, the review secured $1,804,742 in recoveries and realigned payments to appropriate levels.
Duplicate and Improper Bundling in ICU Services - $1,647,840
A regional facility had been overpaid for intensive care services due to duplicate charges and incorrectly bundled procedures. The claims review team identified the inappropriate payments, corrected the billing structure, and successfully recovered $1,647,840, restoring billing integrity and preventing recurrence.
Improper Billing of a Non-Reimbursable J Code - $613,245
A nationwide infusion provider continued billing for a J Code that was no longer reimbursable. By catching the outdated billing practice, the review team recovered $613,245 and provided guidance to eliminate similar errors going forward.
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