Stop Loss Outlier Inpatient Physician Review

Optimizing Stop Loss Outlier Billing with Detailed Itemized Reviews Utilizing OPUS

Stop Loss Outlier

Our itemized bill review service, OPUS, is designed to achieve additional savings of up to 40% on every bill. Outlier rules in certain fee schedule states mandate that bills at predetermined thresholds be paid at a percentage of total billed charges instead of the normal fee schedule.


Savings Impact

Up to 40% additional savings beyond PPO reductions

WellRithms ensures that payors are not overpaying by manipulating the system.

Unfortunately, some providers take advantage of outlier rules by using inflationary billing tactics to increase prices and secure higher payments. Payors unknowingly lose millions of dollars annually through this problematic loophole. Our team at WellRithms exposes these overcharges and ensures the allowed charges are accurate. Allowed charges are significantly reduced before the outlier adjustment is applied.

Our process is designed to remove services that are incidental, bundled, or included in the primary procedure. Also, we ensure charges are consistent with the hospital’s reported costs submitted to the Centers for Medicare and Medicaid Services (CMS).

Want to Know More?

Let’s talk about how we can level the paying field by fighting for fair reimbursement.

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