By Craig Gottwals
80–90% of hospital bills contain errors.
One of the most undervalued aspects of an open-access, self-funded plan backed with reference-based pricing is that we are not limited in our audit capability. You see, many (if not all) of those PPO arrangements you purchase when you “self-fund” with a national carrier severely limit your ability to audit their work.
Makes perfect sense, right? Sure does, for them.
Our self-funded plans never take the hospital bill at face value. Every single bill over $2,000 gets a set of human eyes on it. Line by line. Whether it’s a provider charge or a hospital invoice, we physically review it before payment.
What happens when you do this?
You catch things machines and many repricers will never see. In fact, we consistently claw back 10% savings within individual hospital systems through billing reviews alone, before considering the additional savings from reference-based pricing.
Had enough yet?
