Five Hospital Arizona Health System Boosts Collections by Recovering $459K and Preventing Future Medication Underpayments

Key Takeaways

• Health system identified significant underpayments tied to a high cost antibody therapy medication

• Titan audit uncovered incorrect billing unit configuration within the Charge Description Master

• $459K recovered across approximately 50 patient accounts and billing processes corrected to prevent recurrence

Overview

A five hospital health system in Arizona began experiencing unexpected underpayments related to a high cost antibody therapy medication. Concerned about growing revenue loss, the organization engaged Titan Health’s Zero Balance Audit team to investigate and resolve the issue quickly.

The Challenge

The underpayments had persisted for nearly three months before the issue was identified. Titan was tasked with determining the scale of the financial impact while simultaneously identifying the root cause and implementing a permanent solution to prevent continued losses.

The Solution

Titan discovered that a new HCPCS code for the medication had been introduced following an industry update. When the code was added to the hospital’s Charge Description Master, billing units were configured incorrectly. The system billed one unit for every 100 milligrams of medication rather than one unit for every 10 milligrams, significantly reducing reimbursement for payers that reimbursed on a per unit basis.

A detailed audit identified approximately 50 affected patient accounts. Titan notified the health system of impacted payers and guided the organization through correcting the CDM configuration to align billing units with the intended reimbursement structure.

The Results

Titan recovered $459K in lost revenue across the identified accounts and helped implement corrected billing configuration to ensure future claims would be reimbursed accurately. The engagement eliminated an ongoing source of underpayment and strengthened internal controls around future code updates.

By the Numbers

$459K recovered across approximately 50 patient accounts.