The health plan audits and continuous monitoring we provide at TFG Partners are expected to benefit from the Federal Hospital Price Transparency Rule that took effect on January 1, 2021. It requires hospitals to post prices online for 300 services, including MRIs, heart procedures and surgeries, joint replacements, new patient visits, and lab tests. Read more
Each year in the United States, health care costs increase. It’s something we watch every day at TFG Partners as we conduct claim audits. Rising costs are a budget issue for businesses, the government, and all of us as individuals. Therefore, the search is always on for ways to reduce costs. In the past couple of years, combining health and pharmacy benefit administrators was heralded as a way to do it. Yet a survey of corporate benefits executives found that only 50-percent had confidence it would work. The rationale from the combined companies is that cost-savings result when fewer entities are trying to earn a profit. Read more
After a freestanding emergency room billed an Austin, TX, man’s insurance carrier $10,984 for a COVID-19 test, the case has come under scrutiny. Ironically, the man is a physician and had been on staff at the emergency care clinic. The case has gained widespread attention after the doctor left his job and reported the incident to the nonprofit investigative journalism organization Pro Publica. Read more
Rarely does an event occur that affects a company’s unexpected medical plan expenses as is the case COVID-19. The Kaiser Family Foundation estimates coronavirus treatment for the average patient without complications averages $9,763. If someone has complications, it doubles to a cost of $20,292. The Kaiser researchers arrived at the numbers by tracking and reviewing hospital costs of patients with pneumonia. Read more
There is enormous financial and plan performance value in continuous monitoring of benefit claim payments. When you entrust a health insurer or other administrator to process claims for your self-funded plan, you hand them an open checkbook in many regards. While much of what they do goes as expected, a surprising percentage falls outside of the agreed-on parameters. It means plan members (your employees) may not be receiving the most effective outcomes, and costs can rise needlessly. Some of the processing abnormalities are inadvertent, and others may be more purposeful — because no one thinks you’re watching. Read more