From 2% PPO Savings to 97% AMPS Savings

  • 301426 – $138,071 GBC / $4,625 AMPS Allowed (Savings: $2,223 PPO (2%) vs $133,446 AMPS (97%))
  • $118,630 — Adenosine Stress Test Never Administered
  • $4,922 — Unbundling & ER to Inpatient w/ Emergency Department left on bill
  • $9,894 — Excessive charges adjusted (Reasonable and Customary)
AMPS – Doctor Recommendation: 1/24/2016 – Dr. Doe

All medical records were reviewed. The patient was seen on consultation by cardiology on 11/6 (day 2) to evaluate for chest pain. The consult notes indicate that the pain was not likely cardiac. The notes stated an adenosine stress test would be considered but this test was never performed most likely because the results of a previous HIDA scan showed biliary calculus deposits. The patients pain was attributed to this as all of his cardiac markers had remained unchanged including serial EKG’s. …the (adenosine) test was never performed and the MAR shows no administration of this medication and there is no adenosine stress test report included. Deny the entire charge for Adenosine.