the real cost of inpatient claim errors
DESCRIPTION
Over the last decade, the number of facility claims exceeding $100,000 has grown at an unprecedented rate. In 2000, there were three million-dollar facility claims per one million patients in the United States. Today, there are 34 per one million. The average cost of a high-dollar claim has also increased dramatically, from approximately $86,000 in 2000 to $260,000 in 2013.TRANSCRIPT
Duplicate Billing
The Real Costof Inpatient Claim Errors
Identifying Errors
Over the last decade, the number of facility claims exceeding $100,000 has grown at an unprecedented rate.
In 2000, there were three million-dollar facility claims per one million patients in the United States. Today, there
are 34 per one million. The average cost of a high-dollar claim has also increased dramatically, from
approximately $86,000 in 2000 to $260,000 in 2013.
© 2014 Verisk Health
Learn more about how Verisk Health can prevent overpayment at
The Potential ImpactOn average, Inpatient Claim Review can identify $1.2 million in annual savings, based on 1,000 claims per
month and an average of $100 savings per claim.
www.veriskhealth.com/inpatientclaimreview.
Source: Verisk Health
Within inpatient claims, many error types occur. We’ve collected the most common and
identified the following examples during our various reviews of client claims:
Overcharging
Misbilling
Multiple chest x-rays were performed bedside at $361 each. The same
test, when performed in the radiology department, costs $160.
A standard metabolic panel lab test was labeled as “rush” and billed
at $3,346 vs. a non-rushed basic panel at $1,348.
During one patient’s stay, 16 saline flushes
totaled $1,072. This should have been
included in the charge to administer
antibiotics intravenously.
A 65-year-old male patient admitted for knee replacement was billed for newborn labor and delivery charges.
Upcoding and Upselling
Un bu n d l ing
Duplicate Billing
Additional Errors
MON TUE WED THU FRI SAT
The charge for a single
dose of acetaminophen
for a 325 mg dose of
ibuprofen
charged for a toothbrush for an emergency
appendectomy patient
80%of hospital claims contain errors
The 2011 error rate in
Medicare FFS was 7.9
percent, resulting in almost
$28 billion in overpayment
$28Billion
$14.50 $10
$1,000
A 30-year-old male was
admitted for uncontrollable
seizures. He was discharged
after 48 hours but billed for 72
hours of EEG monitoring.
A patient was billed for a
four-day hospital stay but
discharged after just
two days.
Due to a computer glitch, a patient was billed in triplicate for every lab test during a six-day stay.
Excess:
Excess:
$1,072
3x 3x 3x 3x 3x 3x
$3,346
$201 each$
2days
A processor allowed
a room charge on
the day of discharge.
The biller submitted drug
charges exceeding the
allowable maximum
dosage of a specific
drug per day.
3days 2 authorized
A processor allowed a three-day stay when
the payer only authorized two days.
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation
Source: Kaiser Family Foundation