How to Drive Leadership and Profitability through Operational Improvements Like Utilizing our AllPayor Software
June 1, 2017
How Your Organization Can Avoid Being Over-billed by Utilizing AllPayor Software
A hospital can make simple mistakes which when accumulated over time could lead you to pay more than the actual bill. Since medical billing systems are so complex, avoiding errors can be difficult. Most of the time it is human errors that arise from incorrect data entry which is nearly impossible to catch in a large bill. Insurance companies are then charged for a wrong amount causing their organization to waver from optimal performance.
Disputing Overbilling Without Software
A larger bill leads to larger insurance premium for patients therefore not only is your organization affected but also the clients. One such error occurred in Mount Sinai Hospital when they billed Medicare wrongly for 110 of the 261 patients in their inpatient and outpatient units. This was discovered during the audit report filed for the budget year 2012-2013.
The claims that went against the Medicare billing requirements amounted to around $1.4 million which was paid to the hospital as an overpayment. The Officer Inspector General for the U.S. Department of Health and Human Services reviewed the report and estimated that the Mount Sinai Hospital has received a minimum total of $41.9 million as overpayments from Medicare. The hospital was requested by the OIG to return the estimated amount during the recovery period and spend all resources to identify the actual amount that was owed. Moreover, they were requested to return any additional payments received after the audit period.
The Mount Sinai Hospital, however, disagreed with the report and maintained that all claims filed were in strict compliance with Medicare rules. They also added some claims were filed before the Medicare opening. The hospital rejected the OIG’s report as flawed and based on faulty interpretations made from a small sample of claims. They asserted the claims were made after thoughtful deliberation by extremely qualified physicians.
What AllPayor Can Do for Your Company
The example above illustrates how overbilling is an error that cannot be rectified if it is identified at a later stage. The only way to solve this problem would be adopting a software which manages all claims and models’ contracts for your healthcare service. One such software is MCA AllPayor which is a user-friendly and robust solution to address all types of problems faced by healthcare companies.
The AllPayor software calculates the expected benefits for each plan prior to the claims which are then used to compare the actual amount after the payment is processed. The system has identified errors such as overpayments all across the country worth tens of millions of dollars over the years. AllPayor has shifted the landscape of transparency and pricing in the healthcare industry by duly playing its important role. This is why the software has been adopted by organizations all over the country and continues to help population health insurance providers serve their clients with the best service at a nominal fee.
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