Practice Management Alert

Plus, Aetna offers free rescission reviews.

Would you notice if you billed a $146 service and your payer paid you $36,180? That's the type of error made by Trailblazer Health Enterprises that the Office of Inspector General (OIG) uncovered in a recent audit of -high dollar payments.-

According to the audit report, which the OIG released on Aug. 28, Trailblazer incorrectly overpaid $126,171 to providers for high-dollar services during the audit period. Providers who received the inappropriate payments did not, for the most part, return the money to Trailblazer. To read the report, visit www.oig.hhs.gov/oas/reports/region3/30700017.pdf.

In other news:

If you have patients who are covered by Aetna, take note. Patients who are concerned because Aetna rescinded their healthcare coverage -- which typically occurs when the insurer suspects patient fraud -- can now request a second independent review.

Aetna announced in late September that it will offer a free review of policy rescissions. The payer will provide an independent external entity to perform the review, and Aetna will abide by the findings and decision of that panel. Aetna has hired Boston-based MCMC LLC to handle the external reviews for members who want to appeal a rescission. The review panels will each have three independent physicians, according to Aetna.