Self-Insured Group Services
Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits. MBAA Advocates typically uncover provider overcharges and TPA overpayments in the amount of 6 FIGURES for a single plan year!
The heart-wrenching aspect of our business is watching corporations being forced to downsize the coverage they offer to their employees. Companies are forced to make difficult decisionsâ€¦Decrease Benefit Coverage, Drop or Decrease Retiree Benefits, Increase Employee Premium Shares, Claim Bankruptcy, or Close the Business.
Ask Yourself These Questions:
- What error rate does your TPA define as an acceptable error rate?
- When was the last time your company received a refund check?
- Does the 20% to 40% discount really make up for massive overcharges?
- Have you hired an expensive check-writer?
Our affiliates are professional healthcare consulting firms that work with companies to reduce the amount you pay for medical expenses and return your money back to your bottom line.
Our Comprehensive TPA/Provider Audits Include:
- Determine compliance with both the contract terms and plan provisions
- Evaluate accuracy of provider billings and highlight TPA overpayments
- Assess for potentially abusive or fraudulent claims per provider profiling, by evaluating subscriber claim history and other analytical techniques
- We also assist in the recovery of overpayments from providers and TPAs
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Our Comprehensive Hospital Compliance Audits Include:
- Determine if charges on the itemized statement are corroborated by the medical record documentation
- Evaluate charges for conformance with federal billing regulations that govern inpatient/outpatient billing compliance
- Negotiate for fair and reasonable prices for services rendered
Most of these errors result in money being owed to your company and/or your employees. Is your TPA catching these errors?
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