Navigate Itemized-Bill Audit: CPT Medicare Benchmarks Then Lump-Sum Ask

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Navigate Itemized-Bill Audit: CPT Medicare Benchmarks Then Lump-Sum Ask

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In this episode, Sterling reveals the exact sequence for slashing medical bills without relying on vague motivation. It begins with an itemized-bill audit to spot duplicate charges and services never received. Next, CPT codes are compared directly against Medicare benchmarks published on the CMS fee schedule, exposing markups that commonly reach two to four times the allowed regional rate. Only after documenting those gaps does the process move to charity-care applications, which must come first to establish leverage before any payment talk. Finally, a written lump-sum offer—typically 30-50 percent of the original total—is presented with the Medicare data attached, targeting cash-flow incentives that billing offices prefer. The episode stresses that order and evidence matter more than emotion, turning each five-digit code into a negotiation tool rather than a plea for help.

Key takeaways:
- Audit every line item and flag CPT codes above Medicare rates
- Submit charity-care forms before discussing any settlement
- Follow with a documented lump-sum offer citing specific benchmarks

📩 Have questions or want to share your experience? Reach out at medical@senseofthisshit.com.
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