Tom's Take Blog

August 30, 2017

When reviewing health claims, do only the ones that total large dollar amounts need closer scrutiny?

Tom’s Take: The way we have always approached this at Cypress, each health claim should receive careful review. Sure, it’s not as likely that you’ll uncover huge savings with claims that amount to $1,000 vs. $10,000 or more – but every dollar adds up, especially over the course of a year.

 

Some companies have a system in place to automatically flag health claims for further analysis if they go above a certain amount. Is that enough though? Not when you consider all of the things to be watching for.

 

Our Argus Claim Review division works to catch and correct claim issues every day. The team sees so many instances where a simple mistake is made and it balloons into additional charges. Consider these examples:

  • Same procedure charged twice or at different rates
  • Billing codes for treatment get transposed
  • Wrong medications billed for
  • Incorrect listing of who provided care
  • Separating care items that should be bundled together for a better price

 

This is just the start to the list of issues that could come up on a health claim and result in extra dollars billed. If you’re only focused on scrutinizing large claims, there are a lot of smaller unnecessary charges that could be going unnoticed and inadvertently getting paid.

 

Our motto as it relates to health claims: “Small dollar amounts can add up to significant savings over time.”

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