The cost of healthcare continues to rise with no indications of slowing down!
- A recent PriceWaterhouseCoopers study revealed an 84% increase in the just the last 10 years.
- From 2010 to year-end 2013, $1 million+ claims increased by 1,000% and the trend continues.
- Medical costs trend for 2017 shows another expected 8-10% increase.
- With the ACA excise, health plans must continue to decrease spend.
- Medical and Drug advancements continue to add to increased costs.
Therefore, it’s no wonder claims payers are seeking proven cost saving solutions!
We utilize a three-tiered approach to saving claim payors on high dollar claims that ensures the most effective solution is applied on every referral so that we are able to obtain the highest level discount possible for our clients.
- Our most effective approach is to Negotiate settlements directly with providers. All settlements are completed with a sign-off from the provider. As such, we have never had a settlement withdrawn or repealed.
- Unfortunately, some providers refuse to negotiate or settle a claims. When this occurs, our expert coders thoroughly review and analyze billed charges with a Medical Bill Review and Audit which many times uncovers coding errors, unbundling and even fraud.
- Another strategy is to utilize our team of financial & insurance experts who are consistently monitoring true Usual & Customary fees, and apply their expertise and data to ensure that our clients are not overpaying for services. The proper use of this strategy involves a complimentary analysis of the plan’s Summary Plan Document or Certificate of Insurance to confirm the appropriateness of applying UCR. This strategy, many times, provides the client with savings that can be as high as 90% off of billed charges.
Our team of Certified Self-Funding Specialists, Certified Medical Coders, Certified Medical Billing Experts, Certified Municipal Finance Officers, Registered Nurses and Master Negotiators work together to obtain savings for our clients.
- The only Medical Claims Settlement SpecialistsTM in the industry.
- In-network & out-of-network high-dollar medical claims.
- Signed provider releases with no signed release ever being rescinded.
- Continuous discount agreements.
- Example: $75,000 in radiation therapy treatment. Negotiations secured a 40% discount, or $30,000 in savings per treatment.