Problem
A provider billed for a complicated diagnostic-related group (DRG) on a $204,517 facility bill.
Solution
A physician advisor reviewed the high-dollar bill as a part of the facility review, which is a component of the AuditPro product.
Outcome
The physician advisor found that the provider did not document any actual complications to validate a complicated DRG. The DRG was reassigned to a code for the same procedure without complications. This reassignment saved the client $18,364.
Physician advisor saved a client $18,364 on one facility bill
a
“Enlyte has expanded its back-end bill review process to identify additional savings categories and maximize cost containment. These reviews provided us with additional savings and reduced the overall cost of our program.”
—Claims Manager, State Fund
a