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Member Education, the key to a successful RBP program

WebMember Education, the key to a successful RBP program. Education is the basis of a successful health benefits experience, especially when it comes to reference-based pricing (RBP). Creating a robust year-round education program that engages human resource (HR) teams and members leads to better healthcare choices and higher member satisfaction

Actived: 3 days ago

URL: https://claim-doc.com/resources/2020/09/member-education-the-key-to-a-successful-rbp-program/

Audit of hospital inpatient care uncovers coding errors …

WebAudit of hospital inpatient care uncovers coding errors and over-inflated hospital charges Background. ClaimDOC’ s comprehensive line-by-line auditing of healthcare claims uncovers errors that basic claim repricing and auto-adjudication does not catch, leading to greater savings to health plans and beneficiaries.

Category:  Health Go Health

Red Flags Raise Questions: Egregious Charges or Billing Errors

WebCPT code 29882, AS, RT and charge of $16,784.25. Total charges $40,497.50. CPT code 29888 is defined as, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction. CPT code 29882 is defined as, Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral). Modifier AS depicts, an Assistant at Surgery

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6 Questions About Making the Switch to Reference Based Pricing

WebReference based pricing is not an insurance plan; it is a financing strategy that works with the employer-sponsored insurance plans to accomplish these four goals: Reduce costs. Provide more freedom in selecting physicians and facilities, removing network limitations. Give employers control over physician and facility charges by setting payment

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Audit of medical claim identifies hospital error in reported/billed

WebBackground ClaimDOC’ s comprehensive line-by-line auditing of claims uncovers errors that basic claim repricing and auto-adjudication does not catch, leading to greater savings to health plans and beneficiaries. Our audit team analyzes all types of healthcare claims for

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Huge savings after ClaimDOC audit team analyzes outpatient …

WebHigh dollar charges included pharmacy for $43,266.27 and three (3) dialysis treatments for $22,888.26 ($7,629.42 per treatment). Summary. $67,951.25 total billed charges, ClaimDOC pricing $925.44. 99% reduction based on pricing using the 2021 Medicare ESRD dialysis rate with markup. Total dialysis center charges: $67,951.25.

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The Illogic of Employer Health Plan Renewal Increases

WebFourth-quarter has arrived, and brokers are once again negotiating with health insurance carriers on behalf of their clients to reduce renewal increases. Anyone who’s been in the industry for a few years knows this annual ritual. The carrier

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Freestanding Emergency Departments vs Urgent Care Clinics

WebTotal freestanding emergency department charges $10,378.60. ClaimDOC pricing $287.50. Plan Savings: $10,090.50. Percentage of Savings: 97%. Case 2. A 25-year-old male plan member was seen in an urgent care clinic in Missouri for the diagnosis of acute pharyngitis.

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Egregious Charges for Blood Collection/Venipuncture Services

WebFlorida hospital’s cost for CPT code 36415 – $2.59. According to FAIRHealth® data, depending on the locality where services are performed/zip code, a provider charge for CPT code 36415 can range from $15.00 – $40.00 for this service. Based on ClaimDOC 2023 claims data, the average provider charge for CPT code 36415 is $23.72.

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PROJECT UPDATE: Renovation of former fitness center nearing …

WebRenovation of a former fitness center at 3200 Westown Parkway in West Des Moines is complete. ClaimDOC is starting to move workers into the building. Rendering by Shive-Hattery Inc. What: Remodel of former Fitness World facility Where: 3200 Westown

Category:  Fitness Go Health