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Claim of the Week

Claim of the Week: $2,083 Saved

June 2022
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A 37-year-old woman presented at a free standing ER at 2:53am for treatment of a possible UTI which was evaluated with a dipstick urinalysis and treated with an oral medication. The patient was then discharged, 24 minutes later, at 3:17am. The plan would have paid $6,340. Nokomis obtained records and found that the provider billed…

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Claim of the Week: $801 Saved

June 2022
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We will always go to bat for the patient. Our goal is not to deny care, but to deny inaccurate claims. In fact, only 99.3% of our denials are refiled or appealed, because we take an intelligent and holistic approach to reviewing claims as accurately as possible. In this week’s claim of the week, a…

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Claim of the Week: $4,348 Saved

June 2022
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A 58-year-old woman presented to a weight loss clinic for a medical weight loss consult. The clinic submitted four codes-two of which were supported, plus a lung function test and an unlisted diagnostic x-ray code. Unlisted codes often just get paid by health plans, but should always be carefully reviewed. Our expert team of coders…

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Claim of the Week: $2,186 Saved

June 2022
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A patient presented with a lesion on their neck. After evaluation and treatment, the provider billed three codes, of which her health plan would have paid $2,186. The claim looked fine at face value, but when Nokomis received records, our team discovered that none of these charges were supported. While the patient did receive services,…

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Claim of the Week: $8,066 Saved

May 2022
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A patient had an injection in their ankle joint for pain management. Following the injection, the provider charged $16,281, of which the health plan would have paid $8,141. These charges were not supported. Nokomis denied most claim lines, and reduced the bill to $75 – saving the health plan $8,066.

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Bonus Claim of the Week: $1,166 Saved

May 2022
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A patient received anesthesia for an upper GI endoscopy, and their health plan would have paid $1,499. However, the provider charged for emergency anesthesia, which was not supported by the documentation. Ultimately our review reduced the bill for our client to $333 total, saving them $1,166.

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Claim of the Week: $8,907 Saved

May 2022
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A patient presented at a free standing ER for upper respiratory symptoms and tachycardia. The provider charged a level 4 E&M visit, a critical care charge, and interpretation charges for an EKG and a chest CT. After our team reviewed the records, we found that the critical care charge was not supported, and there was…

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Claim of the Week: $8,426 Saved

May 2022
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A provider submitted 17 claims, each with a level 5 E&M code and a charge for a prolonged office visit, including charges for investigational medications for treatment of chronic pain and depression. Nokomis obtained records, and ultimately denied the entire claim since the documentation did not support the claim. It’s important to review claims within…

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Claim of the Week: $3,456 Saved

May 2022
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A patient presented to a free-standing ER with COVID symptoms. Afterwards, the provider charged $4,169 of which the plan would have paid $3,951 for a level 1 ER visit and 7 lab tests. After review, Nokomis denied all of the lab tests because the documentation didn’t support the tests that they billed, ultimately bringing the…

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