Diagnosis-related group (DRG) outlier
For a Blues plan, Optum clinical staff found antifungal agents billed at 10 times the recommended dosage. This saved our client more than $200,000, nearly 85% of the billed charges.
Itemized Bill Review
Our targeted clinical and financial review leverages Centers for Medicare and Medicaid Services (CMS) and clean-claim evaluation to review inpatient facility claims. We work in concert with our clients’ provider relations team, which minimizes provider abrasion.