Case study: Surgical Implant Cost Management

Procedure Type

Anterior posterior 360 lumbar fusion

Employer

Fortune 500 communications company

What Paradigm’s audit found

• Disposable kit (i.e., supplies) billed as implantable hardware
• Hemostatic agent billed (a contra-indicated item for surgical implantation procedures)
• Items implanted were found to be inconsistent with the procedure type
• Implant construct “bill of materials” violations were caught
• Experimental/non-reimbursable items were utilized: amniotic tissue and stem cells

Total billed charges

$251,465

Paradigm recommended allowable

$42,494

Savings

$208,971 or 83%