Air Ambulance Mileage on Claim Raises Auditor’s Red Flag
ClaimDOC’s comprehensive line-by-line review of claims uncovers errors that basic claim repricing and auto-adjudication does not catch, leading to greater savings for health plans and its plan members. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, incorrect coding, unbundling of services and many others. Our claims review is not intended to impact care decisions or medical practice.
In this Audit Spotlight, we focus on an air ambulance claim where the ClaimDOC auditor questioned the milage being reported/billed on the claim.
An air ambulance company in Florida billed air ambulance services on the UB-04 claim/electronic equivalent, 837I. The primary medical diagnosis codes on the claim were reported as rib fractures and traumatic hemothorax due to bicycle accident.
ClaimDOC auditor’s review of the ambulance claim raised questions, noting the mileage listed as 350 miles appeared to be excessive. Ambulance records were requested to support the claim information reported/billed.
Upon review of the ambulance trip record received, it was verified that according to the medical record documentation, the air ambulance mileage provided was 35 miles, not 350 miles as reported and billed on the claim.
Total Billed Charges for Air Ambulance Services: $55,593.00
ClaimDOC pricing: $5,769.02 based on the Medicare air ambulance rate and mileage rate with markup.
Plan Savings: $49,823.98
Percentage of Savings: 90%
ClaimDOC’s Comprehensive Claims Review and Goals
The improper reporting of services, coding/billing errors and egregious charges can complicate matters for members to understand their healthcare bills and payments. Furthermore, these errors can impact the collection of patient balances, build a reputation of providers charging high fees, create burdens for patients having no insurance among a host of other issues.
When an individual receives a questionable or inappropriate bill for healthcare services, an inquiry to the provider and/or health plan should be made to obtain an explanation of the service(s), corresponding charges, and reimbursement.
Our goal at ClaimDOC is to use benchmark charges and costs nationally to negotiate fair and ethical payments. Our high-quality and expert review of claims identifies and prevents improper medical claim payments and maximizes long-term cost savings opportunities. Employers turn to us to establish fair reimbursement rates for their plans allowing them to save money and provide richer benefits to their employees. A win-win for everyone.