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• Billed Charges: $156,314

• WellRithms Reductions: $57,108

• Final Payment: $99,206 (63.4% of billed charges)

Significant Findings

WellRithms conducted its bill review for fee schedule states on a $235,312 bill that was initially reduced to an allowed $156,314. WellRithms then reduced that further, to $99,206, saving another $57,108.

Background

This spine surgery case followed a severe motor vehicle accident in Nebraska, which has a fee schedule for workers’ compensation. The initial charges of $253,312 highlighted the common overbilling practice of incorrectly charging for implants and surgical supplies. Moreover, the plan would have paid the allowed charges of $156,314 instead of the correct amount of $99,206.

Results

Applying WellRithms Classification, Edits, and Audit System, WellRithms embarked on a detailed examination of the bill. As Ira Weintraub, M.D., Chief Medical Officer, noted, “Our process is not just about reducing numbers; it’s about bringing integrity and fairness to a system often clouded by complex billing practices. Even having a fee schedule doesn’t always protect you from coding mistakes.”

Bill Reductions Included

• Implants: Charges for implants were meticulously evaluated. Initially billed at $23,063, with an allowed amount of $18,077, WellRithms lowered that to $15,321 after confirming the actual value and necessity of the implants used during surgery.
• Surgical Supplies: A common area of overbilling, the surgical supplies were billed at $7,000 and accepted at $4,750. Upon review, WellRithms determined these to be included within the surgical package, leading to an adjustment of the charges to zero.
• Operative Suite: The initial billing for the operative suite was $100,000, with an allowed charge of $53,730. After a detailed inspection, the charge was rightfully reduced to $26,000, reflecting a more accurate use of resources.
• Anesthesia: Highlighting a pattern of overbilling, anesthesia charges were initially billed at $16,000 and allowed at $10,700. These services were already included in the surgical suite costs, which warranted reducing the anesthesia charge to zero.

WellRithms’ comprehensive approach reduced the bill by $57,108, reflecting the company’s ability to add significant value even when a state fee schedule sets rates