February 15, 2015

Quality Matters in Claims Management

It’s a fact of life and a fact of healthcare: mistakes happen. People make errors and complexities create confusion. But when it comes to medical claims, unintended errors can lead to enormous costs. Unified’s partner PHX achieves significant cost savings for customers by analyzing claims and discovering billing discrepancies that are then quickly corrected. Here are some actual stories of exceptional results that PHX has delivered to our customers:

Success 1

  • Rheumatoid Arthritis with Rituximab Intervention
  • Total Charges Billed to Client: $200,743.00
  • Allowed amount after PHX stepped in: $21,348.00
  • Savings: $179,396.00

The hospital bill reflected a total of 5,000mg of IV Rituximab administered to the patient over a two-week course of treatment. Trained to examine billing very closely, the nurse auditor at PHX noted a discrepancy in the transcription where the prescribed amount differed from the actual amount for which the client was billed. The nurse auditor contacted the hospital to discuss the financial findings. The next day the hospital acknowledged their error and, just a few days later, a corrected bill was received in PHX’s office, ultimately saving the customer a total of $179,396.00

Success 2

  • Leukemia with Clofarabine Intervention
  • Total Charges Billed Before: $262,386.00
  • Allowed amount after PHX stepped in: $38,812.50
  • Savings: $223,573.50

A leukemia patient received the chemotherapy agent Clofarabine for five consecutive days at 1mg of medicine per treatment. The bill revealed a charge of $52,000 per dosage. With access to Average Whole Pricing (AWP) data from the PHX data warehouse, the PHX nurse auditor saw that the drug typically costs $2,700 per dosage. With this information, the nurse auditor was able to reach out to her contact and negotiate a change in price. Just four days later, the bill was adjusted and the customer saved over $200,000!

Unified is dedicated to providing the best service and saving you and your customers as much money as possible. For more stories on how Unified’s partnership with PHX can benefit you and your customers, visit here.