Date: 01/05/16
No: 2016-3

ADJ 8017329

Significance

CostFirst prevents a Surgery Center from passing on the cost of their third party vendor providers by splitting the bill and submitting charges from two separate entities.

Hearing: Lien Trial 03/02/16, before Honorable Linda Atcherley, SDO

Lien-claimant(s) Lien Balance Resolution
Healthcare Finance Pharmacy $7,895.66 $50.00
Comprehensive Outpatient Surgery Center $16,694.11 $1,000.00
Technical Surgery Support $2,250.00 Take Nothing
Cal Urgent Care $795.00 $50.00
Pharma Finance $3,408.00 $300.00
American Labs $4,084.69 $250.00
Grant Williams $6,717.00 NOI*

Case Facts

Multiple Liens were assigned to CostFirst through OptiMix™, which encompasses from negotiation through trial with no additional defense attorneys fees. The incident involving a lien claimant trying to collect twice for services is described in CostFirst Notable Resolution 2016-1. After that matter was resolved, there was insufficient time to seven other lien claimants. Therefore, the Lien Trial was adjourned.

CostFirst Resolution

At the Lien Trial the CostFirst Expert relied primarily on knowledge of proper coding principals and reasonable charges to leverage savings. As a Certified Outpatient Coder, the Expert was able to demonstrate that the services for Technical Surgery Support should have been bundled into the outpatient surgery center billing and not billed separately. The “NOI” refers to Notice of Intention to Dismiss” which can only be overcome by a showing of good cause for non-appearance.

Conclusion

The combined savings for the 17 liens referred to CostFirst were $85,879.24 or 92%. The file was closed within 90 days of referral.