“Like our Medicare Based Pricing Product, Cost Charge Ratio Based Pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Both eliminate excess charges due to providers artificially inflating their prices for services delivered.”
MyHealthGuide Source: H.H.C. Group, 12/12/2014, www.hhcgroup.com
H.H.C Group, a leading healthcare insurance consulting company, today announced the launch of its Cost Charge Ratio 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 Reference 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.
“Like our Medicare Based Pricing Product, Cost Charge Ratio Based Pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Both eliminate excess charges due to providers artificially inflating their prices for services delivered. They also ensure similar payment for the same or similar services”, stated Dr. Roffé.
For Cost Charge Ratio or Medicare Based Pricing to be successfully implemented, payors will need to garner provider acceptance and minimize balance billing. Providers will have to be willing to accept prompt and reasonable payment as payment in full for their services. H.H.C Group also offers a service to secure agreements with key providers.
It will take time to convert to Cost Charge Ratio or Medicare/DRG Based Pricing. However, those presently paying based on DRGs can start using H.H.C. Group’s DRG Validation immediately to ensure that claims are being properly coded and payment is appropriate for the services provided. As Medicare/Medicaid Recovery Audit Contractor audits have shown, miscoding and 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. H.H.C. Group 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 Claims Negotiation, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), Claim Repricing, Claims Editing, Medical Peer Reviews/Independent Reviews, Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Predictive Modeling, Disease Management and Pharmacy Consulting. H.H.C. Group is one of forty-six URAC accredited IROs. Contact Bob Serber at rserber@hhcgroup.com, 301-963-0762 ext. 163 and visit www.hhcgroup.com.
