By Medical Bill & Claim Resolution (MBCR) | Submitted On September 09, 2012
Studies show that anywhere from 30% to 80% of medical bill charges could be erroneous. So, it is crucial that healthcare payers know the foundation of how medical billing and reimbursements work. This will root out the errors and increase the savings to the employer as well as the patient.
The Problems of Offering Health Care Coverage For those who are self insured, healthcare expenses are usually about 40% to 60% of the profit of the company. Most TPAs (Third Party Administrators) do not have the incentive, inclination or the time to scrutinize every claim submitted on behalf of the company. The TPA gets paid no matter how big or small the bill is.
For small or medium size businesses, you may be struggling to provide health care coverage for your employees. As the prices for healthcare insurance increase, it may even become impossible for you to offer coverage at all. Or if you can, you might have to decrease benefit coverages, drop or decrease retiree benefits or increase how much your employees have to pay for the healthcare insurance plan.
A Way to Contain Costs The reason healthcare premiums go up each year is because the medical expenses of your employees increase. To keep those expenses down, you can install a defense against medical billing errors, overcharges and even fraud.
In fact, healthcare fraud (according to the Center for Medicare and Medicaid Services or CMS) is estimated at 3% to 10% making the money lost this way a truly staggering sum. The defense you can install is to have a medical bill advocate on call to review the bills of your employees. Medical bill advocates are trained to decipher what can be incredibly confusing medical and hospital bills.
For example, overcharges can include duplicate services, fees for procedures that were not necessary and gross overcharges for services. The difference in what hospitals charge can be staggering. In fact, one study done in Northern California dramatically illustrates this issue. In the study, bills for patients who had undergone appendectomies within a certain time period were studied. The study was careful to make sure similar treatments including the length of the hospital stay, were in the focus group of medical bills.
The price charged for appendectomies in the same part of the country ranged from $1,500 to over $180,000. The average cost was about $33,000.
Offering the benefit of reviewing the medical bills of your employees prior to paying them will help contain medical costs and help your employees as well.
MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at www.medicalbillandclaimresolution.com.