Case Studies > Wound Care Claims

Health system rebills services individually and recovers $160K of underpayments

Key Takeaways
  • Health system in Arizona was billing multiple service dates of outpatient wound care on a single claim

  • Titan auditors determined the best way to get the claims paid correctly was to submit separate claims for each individual date of service

  • Titan recovered $160K in underpayments from its half of assigned patient accounts and recommended new billing policy

The Challenge

A health system in Arizona was billing multiple service dates of outpatient wound care on a single claim. Two well-known national payors were inappropriately applying the multiple procedure reduction to wound care services performed on different dates of service, even though that reduction is only applicable to multiple surgical services performed on the same date, during the same operative session.

The Solution

Titan initially attempted to resubmit the underpaid claims, but both payors failed to reprocess the claims correctly. After reviewing the underpayment issue with provider reps from both health plans, it was determined that their claim processing software was not recognizing the separate dates of service on each claim and therefore applying the multiple procedure reduction in error.

Titan auditors determined that the best way to get the wound care claims paid correctly was to submit separate claims for each individual date of service. While this would require a bit more effort from the hospital’s billing staff, it would result in all previously underpaid claims being reprocessed correctly at 100% of the allowable amount for each date of service, as well as all future wound care claims being processed and paid correctly the first time.

The Results

Titan was able to recover $160K in underpayments from its half of assigned patient accounts. We also recommended a new billing policy of one service date per claim for wound care services and trained the hospital’s billing staff accordingly.

By the Numbers

$160K

Amount Recovered