97% SAVINGS ON OUT OF NETWORK SURGERY

Back to Claim Samples
Contact us Now to Learn More

$92,555 (97%) AMPS Savings on OON – Outpatient Surgery

  • 567211 – $95,600 GBC / $3,045 Allowed (97% AMPS Savings (Out of Network, no PPO Discount)) Arthroscopic revision and repair for dislocation of patella - 4 services lines: 2 were excluded, 1 was adjusted per CMS Guidelines, 1 was adjusted for R&C
  • $20,400 - conflicting billing codes not covered on CMS guidelines (i.e. procedure 1 excludes performing procedure 2)
  • $62,748 – Reasonable and Customary adjustment for procedure