Melody™ proves to deliver fair and accurate reimbursement resulting in quick closure of a provider dispute.

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Facility Inpatient Bill Summary

Background - A police officer was injured in the line of duty resulting in a severe open fracture of the heel bone. The police officer was taken to the ER and admitted for treatment. This resulted in a 20-day hospitalization that included multiple surgeries to clean up the wound, repair the fracture, and do skin grafts to reconstruct the foot. When all was said and done, the bill for this service totaled $761,464.

Approach - Upon receiving the itemized bill, Melody identified numerous line items of inflated and disallowable charges, such as:
 

  • $21,220 charge for 4"x4" gauze pads, listed 3x on this bill, totaling over $60K (actual cost: $0.90 per box)

  • Two line-item charges at $8,317 for an unreimburseable wound cleaning irrigation device

  • $3,645 charge for an undocumented implant for foot repair

  • $3,440 charge for ten (10) plaster casting strips, a 8,600% mark-up (actual cost: $0.40/ten strips)

Results - WellRithms reduced the bill by $573,682, and payment of $187,781 was issued to the facility.

 

Dispute Resolved - The facility filed a complaint to WellRithms regarding their reimbursement recommendation. The complaint was countered with WellRithms’ detailed, itemized review revealing the egregious charges for supplies, implants, & surgical fees. The facility decided accepted WellRithms’ recommended payment with no further push back.