BISD MedReview, LLC Audit 2007 Compared to CTI Audit

The BISD hired MedReview, LLC  in 2007 to audit the district’s self-funded medical claims as re-priced through the Texas True Choice PPO network.

MedReview wrote, in part, “During the audit period, the Texas True Choice netowrk delivered an average discount of 34.2% on professional claims, 45.5% on facility claims, and 41.0% on all claims. Please note that these calculations are based on all claims and all providers. It is not uncommon for provider networks to inflate their average discounts by excluding some types of providers that historically, give very small discounts, i.e,. childrens hospitals.”

For a complete copy of the MedReview audit, email Riskmanager@sbcglobal.net  

The recent CTI audit report shows HealthSmart PPO discounts  for the period 10/01/07 – 9/30/08 of 38.8% on profiessional claims, 43.3% on facility claims.

                                                                              Texas True Choice                HealthSmart

Professional                                                         34.2%                                                  38.8%

Facility                                                                  45.5%                                                  43.3%

Onc should be careful in evaluating an auditing firm’s evaluation. This is proof of that.

In the aggregate, based on two different audits by two outside “professional” auditing firms, the discount differential appears to be 1% or less.

Editor’s Note: As we have indicated in a prior post, the CTI audit raises more questions than it answers. The recent lawsuit filed by BISD against HealthSmart should put to rest any questions we have. It will also lead to an opening of Pandora’s Box with unintended consequences, in our opinion.

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