Neonatal Intensive Care Unit Claim Validation Saves Payer Millions

April 18, 2023

A neonatal ICU (NICU) room

Itemized Bill Review + Hospital Bill Audit

A recent review of a 304-day NICU stay claim lead to over 30% findings of disallowed charges for our large national payer client. Based on the billing methodology, NICU and maternity care-related claims can be reviewed using three specific review services. In this particular case, CERIS initially performed an itemized bill review (IBR) and determined a more in-depth, clinical review was needed. A hospital bill audit (HBA) was then performed by requesting the medical records and validating all services were documented, leading to additional savings.

In the initial IBR, CERIS found over $2 million in disallowed charges from routine supplies and services provided by the nursing and facility personnel.

CERIS then found over $600,000 in incremental disallowed charges with a subsequent HBA. The additional incremental savings were attributed to two major provider-billing discrepancies:

  • Point of care lab charges billed with incorrect item descriptions
  • Inhalation treatments billed on the UB, but not documented in the medical record

Overall, CERIS’ reviews were able to uncover over $3 million in billing errors on this claim.

To learn more about how CERIS can help you save, visit our website or call us at 844-868-0058.

Let's partner to a clear path to greater accuracy and cost savings.

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