July 2022 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Mark Nickerson
VP of Business Developement
RBP Strategic Partners, the Key to Long-Term Group Medical Success
The ClaimDOC Sales Team frequently runs across brokers and consultants who have been told very black and white versions of building out a referenced based pricing (RBP) solution for their client. Some programs are pre-packaged vendor stacks with little opportunity for broker input. These off-the-shelf solutions are geared for and generally only competitive in the under 150 employee market. The other end of the spectrum is completely open architecture solutions with no meaningful input from the RBP vendor on what will be the optimal combination. Consultants are told they need to shop for the TPA, PBM, risk, and compliance to complete the RBP offer. This reflects a lazy approach by the RBP vendor, lacks a strategic vision, and should be avoided.
ClaimDOC offers a flexible solution that is Better than BUCA. A comprehensive group medical solution and strategy. Who cares? The answer lies in how credible you feel the RBP solution should be in solving the areas of quality, cost, flexibility, member support/legal, compliance, and metamorphism. Any TPA can hang a shingle and call themselves an RBP player, and there is little barrier to entry for a startup to reprice claims and tout savings. These solutions lack situational expertise developed from years of hands-on experience with the layers of RBP that all lead back to risk and client satisfaction. Ultimately, to craft a long-term plan, you need to focus on the components that define a long-term strategy for RBP success.
Identifying and Addressing Common Medical Billing Errors
A 60-year-old male underwent outpatient surgery at a hospital in Kentucky for the treatment of foot pain and tendonitis.
The hospital submitted a UB-04 claim form/electronic equivalent, which included charges for HCPCS code C1713 defined as, Anchor/screw for opposing bone-to-bone or soft tissue-to bone (implantable) with quantity units of twenty-eight (28) and related charges of $67,150.54 for these implants.
Other hospital charges on the claim included surgery, diagnostic tests, pharmacy, and recovery room, totaling, $58,174.56. Read more...
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
1. Wichita, KS
Six-day hospital stay for the treatment of stroke
High-Dollar Services:
MRIs: $34,709 CT Scans: $33,669.04 Room and Board: $21,256
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
My Member Advocate Teah is amazing to deal with. Not only is she incredibly helpful and prompt, but she is also compassionate and caring. She takes the time to listen to my questions and solve any issue that arises.
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