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Claim of the Week
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,…Continue Reading
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.Continue Reading
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.Continue Reading
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…Continue Reading
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…Continue Reading
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…Continue Reading