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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.
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
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
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
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.
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
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.
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.
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
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