Introduction: COVID-19 has had a profound impact on the healthcare industry, and many patients have required significant medical interventions as a result. In one such case, a patient required a lung transplant due to COVID-19. Although the treatment was standard, the hospital stay was much shorter than the reported average stay of 32 days. However, the facility still charged an astronomical amount of $559,674.39 for the patient's stay and treatment. This case study will examine how WellRithms was able to reduce the bill for this patient and ensure fair reimbursement.
Bill Reduction: Our client, in line with their stop loss allowance for bills greater than $209,000, reduced the bill to 75% of the billed charges, which amounted to $419,755.80. To ensure that the bill was accurate, WellRithms performed a line-by-line analysis of the 29 pages of itemized charges using a process called Cost and Expense Analysis (CEA).
Savings: With the use of the facility's cost report data, WellRithms was able to identify areas where the charges could be reduced. The charges for ICU room and board (revenue code 200), drugs (250), IV solutions (258), and supplies (272) were all reduced. Additionally, the charge of $136,000 for organ acquisition was denied due to the lack of required documentation from the Centers for Medicare and Medicaid Services (CMS).
Conclusion: Thanks to WellRithms' expertise in medical bill review and actual costs of services, the patient's bill was reduced by $151,608.15. This case highlights the importance of a detailed review of medical bills and the potential for finding "more meat on the bone" when it comes to paying for medical services. It is essential to have a thorough understanding of the charges and to ensure that patients are not overcharged for their treatments. The case also underscores the vital role of medical billing experts in ensuring fair reimbursement and cost savings for patients and their insurers.