Archive for August 27th, 2013

New Models Of Payment: Going Direct, & Cutting Out The Middleman

Tuesday, August 27th, 2013

middlemen

In reaction to rising rates from providers and payers, employers – typically self-insured or self-funded employers – are rejecting participation in insurance companies’ networks.

(more…)

California Employees Retirement System Employs Reference Based Pricing

Tuesday, August 27th, 2013

By Melanie Evans

“I don’t think hospitals are afraid of insurance companies,” he said in an interview. “I don’t think hospitals are afraid of employers. I think hospitals are afraid of consumers. If consumers care about price, hospitals care about price. If consumers care about quality, hospitals care about quality.”

(more…)

How To Charge $546 For Six Liters Of Saltwater

Tuesday, August 27th, 2013

http://www.nytimes.com/2013/08/27/health/exploring-salines-secret-costs.html?pagewanted=1&&%2359;_r=0

Charges like these for a bag of salt water are buried in hospital bills that are never reviewed for accuracy, validity, or reasonableness of fees.  There is no possible way to see charges like the ones noted in this article when an administrator/insurer/TPA pays the hospital bill with nothing but a Uniform Billing (UB) in hand.  99% of hospital bills are paid with no reasonable documentation of charges.

Mike Dendy, CEO – Advanced Medical Pricing Solutions (AMPS)                          mdendy@advancedpricing.com