The answers to 5 problems virtually every payer is facing with their cost containment
program.
1
Problem: According to hospital data over
70% of hospital bills have errors.
Solution: Employ only cost containment solutions that negotiate out-of-network
claims after medial bill review to obtain deeper discounts. According to hospital
data over 70% of hospital bills have errors. Medical review services eliminate erroneous
charges and decrease billed charges prior to claim negotiations.
2
Problem: Many blind PPO discounts and other out-of-network services are susceptible
to reversals and provider contested charges.
Solution: Ensure your cost containment service obtains written provider consent
on each and every discounted claim that fall out-of-network. This offers 100% protection
against provider contested charges and zero change of reversals.
3
Problem: States enacting legislation to prevent “blind” and “silent” PPO
repricing threaten the effectiveness of today’s PPO repricing companies.
Solution: Consider supplemental solutions to secondary and wrap networks
now. This will make the transition to alternative services easier in the event the
legislation does pass.
4
Problem: 10-20% of claims fall out of network
even in the most extensive PPO networks.
Solution: Control your discounts in and out-of-network. Use a claims negotiation
services to further in-and out-of-network claims that were not sufficiently discounted.
This allows you to establish a savings expectation rather than be surprised by blind
or silent discounts.
5
Problem: Primary PPO’S combined with “blind” PPO networks
(no logo required) alone cannot effectively compete with large
industry players like BUCA.
Solution: Think outside the box and outside your network to set yourself
apart from the competition. By employing less confining out-of-network services,
members are offered a greater selection of services without losing the savings.
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