Hear this: If you are a self-funded employer or third-party administrator and you don’t have anyone looking at detailed facility claims you are jeopardizing your business.
By Mike Dendy
Employee healthcare contributions have, over time, gone from a no-big-deal 5% contribution 25 years ago to a now-I’m-questioning-my-career-choice 30%. Back then the employer was nearly off the hook when it came to shouldering fiduciary liability for your employee’s health care contributions. Not anymore. That 81% increase (figure 1.1) means that employers and plan administrators have a growing amount of fiduciary liability, to say you have skin in the game would be an understatement…you need to be paying attention.
Hear this: If you are a self-funded employer or third-party administrator and you don’t have anyone looking at detailed facility claims you are jeopardizing your business. Why? Well, you are liable for what happens to the health care plan dollars; it is your fiduciary responsibility to be the protector of those (increasingly co-mingled) assets.
The bottom line is that you, the fiduciary, need to pay close attention to how the money is being distributed. If you don’t audit hospital bills and don’t have a clue about what is being paid, you are hanging your assets in the wind. Don’t risk it. Take the time to audit facility claims; your business and your employees will benefit from your diligence.
Advanced Medical Pricing Solutions (AMPS) is a healthcare cost management company serving the self-funded payer community. AMPS specializes in physician led, technology driven, facility claim review. AMPS primary goal is to ensure medical facility claims are accurate and reasonably paid and to provide alternatives to the non-effective PPO market. Based in Atlanta, GA with offices in Phoenix and Houston, the company provides proprietary solutions that help large and mid-size businesses address rapidly expanding hospital costs. For more information, please visit www.advancedpricing.com.