The medical 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. CONTINUE READING
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. CONTINUE READING
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. CONTINUE READING