Introduction: Medical procedures such as spinal fusions can be expensive, and patients and insurers often face astronomical bills for these types of treatments. In one case, a patient required a two-level spinal fusion with a one-day hospital stay, and the facility charge was an eye-watering $242,898.64. This case study will examine how WellRithms was able to help our client reduce the bill and save thousands of dollars on this medical expense.
Bill Reduction: Consistent with the Kansas stop loss outlier fee schedule for bills greater than $65,000, our client reduced the bill to 70% of billed charges, which brought the total billed charges down to $140,021.01. Using the fee schedule for trauma activation, the client was able to further reduce the nearly $50,000 charge to $5,200.
WellRithms Review: WellRithms reviewed the bill and used their industry-leading understanding of hospital costs and markups to obtain greater savings for our client. Drug prices (revenue codes 250 and 636) were inflated 60% - 627% above costs, but using accurate, current cost data, WellRithms was able to reduce the allowable charges for these drugs from $11,000 to $647. Similarly, charges for CT scans (revenue codes 350, 351, and 652) were exorbitant and were reduced from over $80,000 to $2,300. Supplies were billed as implants for nearly $23,000, but the WellRithms physician review recommended a payment of $6,200 that included a 25% markup. The final payment recommendation dropped the bill below the stop loss outlier threshold.
Conclusion: Thanks to WellRithms' expertise in medical billing and their thorough review of the spinal fusion surgery bill, our client was able to save thousands of dollars on inflated charges. This case highlights the importance of medical billing experts in ensuring fair reimbursement and cost savings for patients and their insurers. It is crucial to have a thorough understanding of the charges and to ensure that patients are not overcharged for their treatments.