Administrative Services
Claims Services
- Cloning: Using software to copy another (more complex) patient’s treatment record to make it appear as if a more thorough examination was done
- Phantom Billing: Billing for services never performed
- Inflated Hospital Bills: Gross overcharges for procedures and/or equipment, for example, $1,500 surgical screws or $500 Tylenol pills
- Service Unbundling: Billing separately for multiple procedures that should have been billed together in a less-expensive bundle
- Repeat Billing: Billing twice for the same procedure, supplies, or medications
- Keystroke Mistake: Entering incorrect codes, resulting in significant overcharges
- Canceled Service: Charging for a previously approved (but then canceled) medication, procedure, or service.
- Unnecessary Treatment: When a provider performs unnecessary tests to bill for them.
Our goal is to adjudicate 95% of all claims, including appeals, within 30 calendar days from receiving a clean claim. Wexford Health has high standards for the financial, procedural, and non-procedural accuracy of our claims processing. To ensure we continually meet or exceed these standards, we have implemented the following claims quality management program.
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