The Audit Program is set up to recognize the Medical Provider’s actual cost to deliver the service and to allow a fair margin above that cost. The Audit Program does not use billed charges as a starting point.
Instead it utilizes transparent and recognized industry sources, with a particular focus on Medicare and the annual cost reports many Medical Providers report annually to the Centers for Medicare & Medicaid Services (CMS).
- GUARANTEE -
If our fee eliminates a financial benefit for the plan on ANY claim, then ALL usual & customary vendor services on that claim will be FREE to the plan.
- CASE STUDY -
SUMMARY
• Member treated at a hospital facility in central California
• Member was treated for chronic cholecystitis (chronic gallbladder issues common with recurring gall stones)
• Member received surgery which was charged at $15,825.44 (billed charges)
• Hospital facility then unbundled the same charges and billed them separately aka Unbundled Charges
• Total billed charges: $56,849.64
• Total Amount Plan Saved: $50,944.34
STUDY CONCLUSIONS
These are charges that never should have been included in the bill. We then reduced
the bill even further per its audit process in accordance with the Plan language, saving the Plan a total of
$50,944.34.
Our deliverable provides numerous opportunities to reduce spending!
We cannot guarantee a percentage of overall spending reductions, however, we can illustrate your current spending and break out each category of current spending and illustrate your opportunities to save. Engagement, accompanied with upper management buy-in and culture improvements, all contribute to your spending reduction.
Our more significant areas of savings are generated from:
- Reference Based Pricing
- Lower Rx Cost
- Population Health Management
- Superior Engagement
- Behavior Management - Lifestyle Risk Calculator
- Effective Wellness
- Improved Efficiencies and Productivity
- Exceptional Healthcare Management
- Superior Self-Insured Contracts
