Bill Review Spotlight: How AI Revealed a $30K+ Medication Billing Error

Next-Gen AI Slashes Costs on Charges for Non-Rendered Services

Imagine uncovering a $30K+ error in a single medical claim using cutting-edge AI technology—our team at Alaffia Health did just that!

Our medical overpayment protection team deployed Alaffia Health's AI platform to scrutinize a complex medical claim, initially billed at $48,706.58.

Here’s a breakdown of how our technology pinpointed and resolved a substantial billing error.

Initial Trigger

The claim, predominantly composed of pharmacy charges, caught the AI's attention due to an unusually high amount—$33,444—billed for 100 units of a thrombolytic drug under a single revenue code.

AI-Driven Review

Automatic Validation: Our AI quickly cross-referenced the medication with treatment timestamps, revealing that the drug was not administered as the patient was outside the effective treatment window.

Charge Discrepancy Identification: Despite non-administration, the total charge for the medication was erroneously billed.

Outcome of AI Review

Overpayment Detection: The AI’s thorough documentation review and cross-checking capabilities revealed $33,344 in overpayments.

Financial Adjustment: Subsequently, the total claim was correctly adjusted down to $15,362.58, slashing the initial amount by an astonishing 68 percent!

Alaffia Health’s AI Solutions Combat Overpayments and Transform Financial Performance

Fraud, waste, and abuse (FWA) take a heavy toll on healthcare payers, costing billions of dollars annually, but this doesn’t have to be you.

Partnering with Alaffia Health allows you to leverage powerful AI technology and turnkey solutions that seamlessly integrate with your current systems to pinpoint and prevent unnecessary overpayments that immediately and positively affect your financial performance.

Beyond immediate savings, our AI ensures ongoing compliance and financial health, safeguarding your operations against future risks.

We invite you to explore how Alaffia Health’s next-generation AI solutions can uncover errors that cost healthcare agencies and companies precious time, effort, and money. Experience our lightning-fast technology, leveraging the force-multiplier effect of an AI workflow, and discover the potential for increased accuracy, efficiency, and significant cost savings for your organization.

So, don’t miss this opportunity to partner with us and optimize your billing process. Contact us today for a free demo and see firsthand how Alaffia Health can transform your billing accuracy.