This week's Bill of the Week highlights the significance of medical bill review and the expertise of our physician review team. We received two bills for the same procedure, a two-level cervical arthroplasty, one from the primary surgeon and the other from the assistant surgeon. However, a surprising discovery was made: both bills attempted to charge for the incorrect procedure, a cervical arthrodesis, in addition to the correct one.
It's crucial to note the difference between these two procedures. An arthroplasty involves replacing the disc between two vertebrae to restore movement, while an arthrodesis fuses the two vertebrae together. It's impossible to perform both procedures.
"Our system flags multiple procedures for physician review, and that team quickly caught the reason for the error and denied the incorrect charges," said Jeff Jahnke, VP of Operations and Bill Review at WellRithms.
The errors didn't stop there. The primary surgeon also tried to bill for a procedure that wasn't performed, "internal neurolysis requiring the use of an operating microscope". Our team quickly denied this charge as well, leading to a reduction of $31,320.50 to $898.35 for the assistant's bill and a significant decrease of $106,799.00 to $4491.79 for the primary surgeon's bill.
"As a surgeon and Assistant Medical Director at WellRithms, I understand the complexity of these procedures and the importance of ensuring accurate medical billing," says Jesse Nguyen. "Having surgeons review complex surgical bills provides us with a unique perspective and understanding of the procedures performed. Our expertise in medical billing allows us to accurately identify errors and discrepancies in the billing process. At WellRithms, we take pride in uncovering these errors and saving our clients money."