Health System Rebills Services Individually and Recovers $160K in Underpayments

Key Takeaways

• Arizona health system billed multiple outpatient wound care service dates on single claims

• Payers incorrectly applied multiple procedure reductions due to claim structure

• Titan recovered $160K and helped implement a billing policy that prevents future underpayments

Overview

An Arizona health system experienced recurring underpayments tied to outpatient wound care services. Claims included multiple dates of service combined onto a single submission, which created unintended payment reductions during payer processing.

The Challenge

Two national payers were applying a multiple procedure reduction to wound care services performed on different dates. This reduction is intended only for multiple surgical procedures performed during the same operative session on the same date of service. Because several treatment dates were grouped onto one claim, payer systems interpreted the services incorrectly and reduced reimbursement.

Initial claim reviews suggested the payments had processed according to automated logic, making recovery difficult without deeper analysis of payer adjudication behavior.

The Solution

Titan auditors first attempted standard claim resubmission, but both payers continued to process the claims incorrectly. Discussions with provider representatives revealed that payer adjudication software was not recognizing separate treatment dates when included on a single claim.

Titan determined that submitting individual claims for each date of service would align billing structure with payer processing logic. Although this approach required additional billing effort, it ensured each treatment would be reimbursed at the full allowable amount.

Titan worked with the hospital to implement the revised approach and provided training to billing staff to support consistent execution going forward.

The Results

Titan recovered $160K in underpayments from its assigned portion of patient accounts. The newly adopted billing policy of one service date per claim eliminated the processing issue, allowing future wound care claims to be paid correctly on first submission while reducing ongoing revenue leakage.

By the Numbers

$160K recovered through corrected billing methodology.