Audit finds $21K in payment errors
Audit Issue
Our client amended its health plan to increase the copay by $10.00 for all office visits including outpatient mental health/substance abuse services.
Audit Finding
When the TPA re-programmed its system to change the office visit copay, it neglected to recognize the procedure code for psychotherapy visits; thus processing benefits at the outdated copay amount.
TPA Response
In its manual review of the documented plan changes for the new benefit year, the TPA overlooked psychotherapy as an office visit procedure, and agreed that overpayments were made in the amount of $10.00 for each psychotherapy visit.
Financial Error
We systemically identified 2,100 psychotherapy office visit charges overpaid in the amount of $21,000 for the calendar year audited.