The Cost Plus Revolution in Texas has saved self-funded employer sponsored health plans millions of dollars (See previous postings by typing in “Cost Plus” in the search box on this page). More Plan Sponsors are realizing that PPO discounts based off inflated medical bills through contracts that they cannot see confounds their fiduciary duties.
Amps (www.advancedpricing.com) works with self-funded health plans. Their proven track record shows significant plan savings for their clients.
Atlanta, GA — Advanced Medical Pricing Solutions (AMPS) recently introduced a new per-employee/per-month (PE/PM) pricing program whereby they provide a guaranteed return on investment to employer groups of their TPA/payer clients.
AMPS, a privately held company, is working with clients across the U.S. to achieve accurate billing by hospitals for healthcare services provided.
“AMPS is a cost containment company and a PE/PM pricing model lends itself just as readily to our efforts as the typical percentage-of-savings model,” said Mike Dendy, CEO/President of AMPS.
“Because of our physician driven audit and review model and our indemnification benefit, we feel confident enough in our outcomes to guarantee an outstanding return on investment to the employer group clients who work with our TPAs,” continued Dendy.
AMPS audits are managed exclusively by licensed medical doctors who perform a line-by-line analysis of every claim submitted for review.
AMPS announced in fall 2009 that the company added indemnification that protects all members of the payer group from loss due to AMPS’ audit and review efforts. “We have consistently found errors in 89% of the medical bills we have reviewed and we have achieved an 18% + average billing reduction over the last four years. This accomplishment is remarkable relative to our industry because the great majority of the claims we review are in- network billings,” said Dendy.
“Payers are beginning to realize that the clauses in PPO contracts that suggest that a bill can’t be audited are both self serving and potentially illegal when hospital billings represent such a huge percentage of any payers cost mix. Further, recent court rulings are pointing to the fact that payers have a fiduciary obligation to protect a plan’s assets and no one can rightfully assert that such has taken place without a rigorous review of hospital bills.”
A story on ABC Good Morning America on April 7, 2009 defined the scope of the medical billing issue, stating that 80% of all medical bills have errors. The origins of these errors include: mismatches – drugs that appear on a medical bill, even though they weren’t listed in the medical records; double charges – the same procedure billed twice, though it occurred only once in the patient’s care program; and, inflated charges: charging exorbitant fees for modestly priced items, which could be everything from aspirin to a prosthesis.
A measurement of the scale of the medical billing problem is the announcement by the New York State Comptroller, Thomas DiNapoli, in December 2008 regarding medical bill overpayments. DiNapoli came out with a statement that the system New York has been using isn’t working. The Comptroller’s office had recently overseen an audit of the system and turned up $1.8 billion in overpayments. That is only one state.
About AMPS Founded in 1995, AMPS now has offices in Atlanta, GA; Chattanooga , TN; and Phoenix, AR. AMPS’ reviews have yielded an average cost savings on adjusted hospital claims of 19.55% (over and above PPO discounts). With an average size of claim reviewed of $51,365, this has yielded an average additional dollar reduction of $10,041 per claim. AMPS average success (hit) rate on claims greater than $15,000 reviewed is 90.5%.
Editor’s Note: We have met with AMPS and have reviewed their contracts. We like what we see.