Identify & Recover Overpayments

Identify and Recover Overpayments

Coding Review

The correct coding review and substantiation processes was developed to assist all self-funded plan sponsors to identify improperly coded medical claims from providers and facilities. GBS is one of eight managing general agents in the US that has access to the platform. This platform assists with both the identification and the recovery of overpayments from planned assets.

Whether intentional or unintentional, mistakes happen when physician offices, labs and facilities code the forms that bill for their services. This includes all insurance types: Medicare, Medicaid, fully insured Insurance plans, and self-funded plans. Health Care Reform and changing from the ICD-9 Codes to ICD-10 Codes will only make matters worse for the plan sponsor.

Identifying these errors requires a specialist. We are experts at finding coding errors. Our processes are proprietary, state-of-the-art, robust and conducts over 3,000,000 edits on every claim looking for errors. The correct coding review is an independent due diligence of a plan sponsors medical paid claims. It is fiscally prudent to perform. There is no doubt that claim Administrators will catch some billing/coding errors; the question is “what incorrect codes are being missed by your administrator’s processes”? Many administrators tout a high percentage of claims being auto-adjudicated…there is no one watching over the bills when auto-adjudication occurs. There is NO INCENTIVE for an administrator to protect the outflow of dollars as the dollars do not belong to them.

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Here are some articles, press releases and links regarding miscoded bills and overpayments made to providers:

  • Insurance & Financial Advisor: “Health insurers denying fewer claims, but payment errors increasing”
  • Fierce Healthcare: “Whistleblower accuses Adventist Health of overbilling millions” – view pdf
  • 14 hospitals to pay $12M over false surgical claims
  • Atlantic Health System to pay $9M for alleged Medicare overbilling
  • Group affiliated Florida Hospitals agree to pay US $10.1 Million to resolve false claim allegations
  • How doctors and hospitals have collected billions in questionable fees
  • CNN Expose – “The $1,000 Toothbrush” – view here
  • Health Care Hidden Cost – NBC Connecticut – view here