MyHealthGuide Source: H.H.C. Group, 9/20/2011, www.hhcgroup.com
Now there’s a better option than PPO discounts. H.H.C Group, a leading healthcare insurance consulting company, announced the launch of its Medicare/DRG Based Pricing Service, designed to help payors of all sizes reign in ever increasing provider related costs.
“PPO discounts have been only partially successful in controlling spiraling provider costs. Many larger insurers have already made the switch to Medicare/DRG Based Pricing or are considering doing so, putting all who compete with them at a serious disadvantage”, said Dr. Bruce Roffé, President and CEO of H.H.C Group.
“Medicare/DRG based pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Medicare/DRG Based Pricing eliminates excess charges due to providers artificially inflating their prices for services delivered. It also ensures similar payment (Medicare makes adjustments based on geographic and other factors) for the same or similar services”, stated Dr. Roffé.
As with any change, there are a number of issues to be considered. The first is provider acceptance. To maximize acceptance by providers, the multiple chosen must generate a fair return for the services provided. Second, is balance billing. Providers must be willing to accept prompt and a reasonable payment as in full payment for their services. Securing agreements with key providers will be essential for success. Third, is implementation and maintenance. Medicare rates are constantly changing. H.H.C. Group can secure agreements with key providers and ensure the latest rates are applied while consistently process all claims on an expedited basis.
While it will take time to convert to Medicare/DRG Based Pricing, all size payors can start using H.H.C. Group DRG Validation right now to ensure that claims are being properly coded and payment is appropriate for the services provided. As Medicare/Medicaid RAC audits are showing, miscoding up-coding errors are extensive and the potential for savings huge.
About H.H.C. Group
H.H.C. Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. HHC utilizes a combination of highly skilled professionals and advanced Information Technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.
H.H.C. Group’s services include Captive Insurance Programs, Medicare/DRG Based Pricing, DRG Validation, Claims Negotiations, Repricing, Medical Bill Review (Audit), Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining/Claims Scrubbing, Predictive Modeling, Disease Management and Pharmacy Consulting. H.H.C. Group is one of forty-four URAC accredited Independent Review Organizations.