Report: Rural Hospitals Charge 63% Less Than Urban Hospitals

April 23rd, 2014


Rural hospitals are equal to their urban counterparts in care quality, patient safety and outcomes, and their emergency departments (EDs) are more efficient and less expensive, according to a new study by iVantage Health Analytics.

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Pinder – Bringing Pricing Transparency to Health Care

April 22nd, 2014
Posted by  on April 22, 2014


“People should know what things cost in health care,” said Jeanne Pinder, founder and CEO of “We’ll use the power of our communities to reveal the secrets of the marketplace, and join hands to make this opaque system more transparent.”

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Reference Based Pricing Using Offshore Pricing for High Cost Drugs

April 22nd, 2014


PPACA does not mandate where a service or covered product is to be purchased.  If you can get a full course of treatment for Sovaldi for $900 in Brazil versus $33,600 per month in the United State, it may make sense to export the patient as opposed to importing the drug.  Sitting on a beach in Brazil with an umbrella drink in between treatments sounds appealing.

Clinical Newsletter March-April 2014 (1)

Sun Tzu “The Art of War” – The Lay of The Battle Ground – Is Adam Russo Sun Tzu’s Prodigy?

April 20th, 2014


“Many benefit plans are bound by contracts they either don’t understand or have never seen” – Adam V. Russo

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Why Make A Federal Case Out Of A $1,300 Debt?

April 18th, 2014

“Now, why should hospitals be concerned?  Two reasons………...”confused-face2

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Texas TPA Offers Cash Plan To Medical Facilities?

April 17th, 2014

cashplan   By Molly Mulebriar

Cash is King, especially in the medical reimbursement arena. Members of the 50% Club can attest to that. (Type in “50% Club” in search box on this blog).

Hospitals offer deep discounts for cash, often better pricing than  managed care contracts. Contrary to representations of the BUCA’s,  size means nothing. A lone patient with cash can always  beat the big boys in health care pricing.

Imagine  an employer sponsored health plan transitioning to a Cash Plan and the savings to be realized. Turning plan participants into cash paying customers – Is that possible?

A Texas TPA says it is not only possible, they are doing it.”  Borrowing on the PBM method of financing, a line of credit allows the TPA to negotiate and pay facility claims quickly and efficiently.

A recent claim transaction illustrates the effectiveness of this approach. A  gross billed charge for an outpatient procedure of $12,000 was reduced to less than $2,000 with a cash pre-payment by the TPA using their own line of credit to fund the payment. At the end of the month, the TPA recouped their funds through a claim draft against the Plan Sponsor’s claim account. The PBM financing model is now extended to include medical claims.

We knew it was only a matter of time someone would think of this and actually do it. (My father invented the weed eater in 1955 but never bothered to obtain a patent, much less build one). Turning ideas into action is hard for some.

Of course, it’s not as simple as one would expect. Plan document language and stop loss contracts must mirror the scheme. But details are someone else’s problem, right Uncle Hermann?

Editor’s Note: Molly Mulebriar is a free lance reporterette from Waring, Texas.





Agent – Broker – Consultant E&O Liability under PPACA

April 14th, 2014

bareUnder-Insured Insurance Agent/Broker

Insurance agents, brokers and consultants better dust off their E&O policies and read them. There is a good chance they may not be covered in areas they need to be due to increased exposure under PPACA. For example, is there coverage for self-funded employee welfare plan sales, service and recommendations? If so, is there a policy sub- limit such as $250,000? Giving advice as a fee based insurance consultant  is almost never covered under most group E&O policies, does yours? Probably not. In fact, one would probably need to go to the surplus lines market to find adequate coverage these days. And what about cost? Standard group A&H E&O policies run around $400-$700 per year. Adequate coverage  can cost thousands of dollars per year.

Going bare is risky these days………….

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Walgreens Urged To Leave United States To Gain Tax Benefit

April 13th, 2014

By Ed Hammond in New York

Walgreens has come under pressure from an influential group of its shareholders, who want the US pharmacy chain to consider relocating to Europe, in what would be one of the largest tax inversions ever attempted.

Editor’s Note: Exporting patients and companies seems to make economic sense these days.

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AMPS CEO Featured In Business Insurance Article

April 13th, 2014


AMPS‘ CEO, Mike Dendy, Featured in Business Insurance Article: Medical bill reviews and audits can help employers lower health benefit costs

“A uniform bill is a single piece of paper or electronic document that summarizes the services provided,” said Mike Dendy, CEO of Advanced Medical Pricing Solutions, a medical bill review service based in Norcross, Ga. “It might have something like ‘pharmacy’ with no details. Every payer in the country takes that uniform bill and writes checks on their clients’ behalf.”

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Assent Medical Cost Management Launches MAXpay – A Reference Based Pricing Model

April 13th, 2014


MIAMI, FL–(Marketwired – Mar 12, 2014) – Assent Medical Cost Management (Assent) announced the launch of MAXpay, a fixed dollar reference based pricing program. Targeting Self Insured Plans, MAXpay increases control over healthcare expenses by setting reasonable and fair benefit limits. To determine reimbursements, MAXpay utilizes cost data, multiples of Medicare reimbursement and Medicare-like methodologies, all of which are fully defensible.

Editor’s Note: Cost Plus Insurance /  Reference Based Pricing is a growing market phenomenon - Xerox, Eastman Kodak And Cost Plus Insurance

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