Duplicate Billing

The Real Costof Inpatient Claim Errors

Identifying Errors

Over the last decade, the number of facility claims exceeding $100,000 has grown at an unprecedented rate.

In 2000, there were three million-dollar facility claims per one million patients in the United States. Today, there

are 34 per one million. The average cost of a high-dollar claim has also increased dramatically, from

approximately $86,000 in 2000 to $260,000 in 2013.

© 2014 Verisk Health

Learn more about how Verisk Health can prevent overpayment at

The Potential ImpactOn average, Inpatient Claim Review can identify $1.2 million in annual savings, based on 1,000 claims per

month and an average of $100 savings per claim.

www.veriskhealth.com/inpatientclaimreview.

Source: Verisk Health

Within inpatient claims, many error types occur. We’ve collected the most common and

identified the following examples during our various reviews of client claims:

Overcharging

Misbilling

Multiple chest x-rays were performed bedside at $361 each. The same

test, when performed in the radiology department, costs $160.

A standard metabolic panel lab test was labeled as “rush” and billed

at $3,346 vs. a non-rushed basic panel at $1,348.

During one patient’s stay, 16 saline flushes

totaled $1,072. This should have been

included in the charge to administer

antibiotics intravenously.

A 65-year-old male patient admitted for knee replacement was billed for newborn labor and delivery charges.

Upcoding and Upselling

Un bu n d l ing

Duplicate Billing

Additional Errors

MON TUE WED THU FRI SAT

The charge for a single

dose of acetaminophen

for a 325 mg dose of

ibuprofen

charged for a toothbrush for an emergency

appendectomy patient

80%of hospital claims contain errors

The 2011 error rate in

Medicare FFS was 7.9

percent, resulting in almost

$28 billion in overpayment

$28Billion

$14.50 $10

$1,000

A 30-year-old male was

admitted for uncontrollable

seizures. He was discharged

after 48 hours but billed for 72

hours of EEG monitoring.

A patient was billed for a

four-day hospital stay but

discharged after just

two days.

Due to a computer glitch, a patient was billed in triplicate for every lab test during a six-day stay.

Excess:

Excess:

$1,072

3x 3x 3x 3x 3x 3x

$3,346

$201 each$

2days

A processor allowed

a room charge on

the day of discharge.

The biller submitted drug

charges exceeding the

allowable maximum

dosage of a specific

drug per day.

3days 2 authorized

A processor allowed a three-day stay when

the payer only authorized two days.

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation