The Real Cost of Inpatient Claim Errors
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Duplicate Billing The Real Cost of 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 Impact On 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 U n b u n d l i n g 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 $28 Billion $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 $ 2 days 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. 3 days 2 authorized A processor allowed a three-day stay when the payer only authorized two days.
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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.
Transcript of The Real Cost of Inpatient Claim Errors
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
