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
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