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Field notes on claims integrity
What billing errors look like, what ERISA requires, and how recovery actually works. Everything here is what we do all day.
Featured teardown
Anatomy of an overcharged inpatient claim
A duplicate scan, an upcoded visit, an unbundled panel, and an overstated stay. Four errors on one bill, walked through line by line.
Teardown · inpatient claimIllustrative
71046Chest X-ray, billed twice$610Duplicate
99285ER visit, notes support level 3$2,730Upcoded
80053One panel billed as 14 assays$1,340Unbundled
R&B4 days billed, 3 day stay$3,912Overstated
Recovered from one bill$14,380
Figures are illustrative.
The blog
Our blogs
Why self-funded plans fall under federal ERISA law
What fiduciary duty means when the plan pays its own claims.
Upcoding vs. unbundling: how to tell them apart
The two most common errors, and how each shows up on an itemized bill.
Medicare rates, FAIR Health, and what a fair price means
The data that turns "that looks high" into a dispute.
The summary plan description is the audit rulebook
Every dispute is judged against this document. Keep it current.
Auditing the TPA, not just the provider
Adjudication has its own error rate. Someone should check it.
Triage: where the recovery hides
High-dollar claims first. Inpatient and surgical bills carry the highest error rates.
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