Case study: Surgical Implant Cost Management

Procedure type

Calcaneus Open Reduction Internal Fixation

Employer

National Construction Employer

The Paradigm solution

Paradigm’s Surgical Implant Cost Management review found the following billing observations/themes:

• Multiple disposable items (i.e., supplies) were inappropriately billed as implants
• Numerous items billed as implanted, but removed, prior to the conclusion of the procedure
• Facility submitted invoices for items not supported by medical documentation (i.e., excessive billing)
• More invoices submitted than billed, by the facility, requiring detailed item-to-procedure matching
• Several non-reimbursable items were identified based on the procedure (i.e., ancillary supplies)

Total billed charges

$54,884.30

Paradigm’s recommended allowable

$3,156.94

Savings

$51,727.36 (94% savings)