by Dr. Franco Mueller
Partner/Medical Director, TFG Partners
We remain a bit skeptical of the studies mentioned in our previous post from KHN. Please look at the study dates, the data is from between 2007 and 2013. Many Pharma companies have boosted the price in the last two years and we are just seeing costs continue to skyrocket. There are more problems facing employers then just orphan drugs in the industry pipeline. The issues go much deeper into the pharmaceutical industry and orphan drugs are just one part of the horizon. more
by Ryan Jerico
Senior Consultant, TFG Partners
Truthfully, this is not an “I told you so” situation, but…. look at Dave Chase’s piece in Forbes and well….
For many years TFG Partners has been providing clients with in-depth audits via our 100% methodology. These medical plan claims audits routinely uncover issues of Other Party Liability, Duplicates and Coding issues and Plan Benefit compliance.. While there can be significant savings from correcting these administrative weaknesses, uncovering issues surrounding provider contracts, administrator policies that conflict with the plans’s benefits documents and intent, and shifting numbers in calculations to meet discount/performance guarantees has always been particularly troubling to us as auditors. Most of the time, our clients have shared our concerns and moved forward to have these issues corrected and recover dollars to the plan. We have also seen plan sponsors fail to act on the information presented.
Be sure to join us on May 11th for our upcoming webinar outlining strategies to help better manage your PBM. With costs in the Rx space skyrocketing, many plan sponsors are looking at changes to plan design, drug tiers, and delivery channels to increases. There are ways to ensure your plan is running as efficiently as possible without disruptions to your members. Allow us to share some data-driven strategies to contain Rx costs by managing your PBM.
Recently, Partner and Chief Medical Officer, Franco Mueller, MD held a training with our audit and program team to address the upcoming transition to the new International Classification of Disease Code 10. Most of the world has already adopted this new iteration of disease coding. However, as part of HIPAA compliance, the United States will move into complete compliance by late 2014.
As Auditors, we at TFG Partners strives to keep on the cutting edge of all medical and technical coding. This transition will be seen in our retroactive audits in the next plan cycle. Being cutting edge in training for this transitions will enable TFG Partners to continue to give our clients the best in industry experience they have come to expect.
More information on ICD codes and the transition:
ICD-10 – Centers for Medicare & Medicaid Services.
More information about ICD Codes – About.com
Along with the launch of our new TFGPartners.com website we are proud to also launch this Healthcare Informatics Blog. We plan to focus on current events which would be most influential to our clientele, large self-funded health plan managers. However, in these turbulent times in healthcare with Healthcare Reform, skyrocketing costs, and a rebounding economy this type of information is likely important for everyone to know.
Our goal with this NewBlog is to aggregate and categorize information for easy reading. We hope you will give us feedback along the way by reaching out and contacting us .