Moving away from managed care contracts can be fraught with nightmares of ruined credit. No one wants to be classifed as a deadbeat and go to court. What say you, Bill OReilly?
Continue reading Bold & Fresh – “We Guarantee No Balance Billing”
Day: December 13, 2012
Another Third Party Administrator Touts Cost Plus Insurance – New Market Trend?
Moving away from managed care contracts is becoming a major trend of late. We are seeing more third party administrators entering into cost plus reimbursment strategies in an effort to reign in ever increasing health care costs for their clients. We have identified at least eight (8) TPA’s who are active in Cost Plus Insurance.
Now we find one more TPA active in the Cost Plus Insurance market – Payer Fusion:
“Our unique approach to claims reimbursement creates significant savings for our client partners while allowing providers a fair reimbursement based on the actual costs of service. Our unique Cost-Plus Pricing Methodology assesses each claim compared to national data reported by federal agencies. Utilizing this data we are able to determine the actual cost of service, needs of the provider to offset losses from Medicare patients and the fair retail cost of the service provided.”
https://payerfusion.com/ceos-blog/cost-plus-methodology
Editor’s Note: As was the case with the $3 hand calculator retailing for $100 in 1972, so goes the cost of administrating health care plans using cost plus strategies. Competition is a good thing.
Proposed EHB Benchmark For Texas
http://cciio.cms.gov/resources/EHBBenchmark/proposed-ehb-benchmark-plan-texas.pdf
Self-insured group health plans and insured large group health plans are not required to cover so-called essential health benefits – but they are prohibited from imposing annual or lifetime dollar limits on any essential health benefits that are covered.
Source: Vorys
Health Plans Must Pay Reinsurance Fees & Other Employee Benefit Updates
The regulatory agencies (the IRS, DOL, and HHS) have started to fill in some (but by no means all) of the gaps in the Affordable Care Act guidance needed to implement the transformation of health coverage that is supposed to happen in 2014. Here is a rundown of new guidance relevant to employers that sponsor group health plans for their employees.
Continue reading Health Plans Must Pay Reinsurance Fees & Other Employee Benefit Updates