Eliminate the Change

Through our provider repricing solutions, we duplicate how a health plan prices a medical provider’s claims based upon several factors, including but not limited to the provider contract and each health plan insurance product.? While it may appear to be straightforward, the process of pricing a medical claim is a “Rubik Cube” process with several factors aligned to price the claim accurately.? The inability to accurately price a medical claim or determine its allowable is the root cause of the high cost of healthcare payments for all parties.???

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Despite tremendous investments in revenue cycle, contract management and various healthcare payment technologies, adjudicating a healthcare claim is facing rising costs and less effectiveness for payers and providers alike.?

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One simple and easy step that would reduce the complexity and cost of collection for everyone would be rounding up or rounding down the allowables to a flat dollar amount.? Eliminate the change!? For example, there are multitudes of allowables that have a change in their pricing, i.e. $158.01.? Why not make the allowable or price $158.00????

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These less than flat dollar allowables are prevalent and represent most of the prices for the major plans.? In fact, the same managed contract covers multiple-payer products with slightly different prices, by cents.? This pricing variance by payer creates high hurdles to overcome for price transparency, revenue recognition, and account receivable resolution.? Medical providers are writing off small balances as a rule, but these irrelevant dollars affect self-pay amounts which are increasing due to high deductible plans as well as creating significant wasted effort of claim appeals and cost higher cost of collection for payers and providers alike.?

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Is it about time we change the cost and process of healthcare collections for everyone??

Media and Marketing:

Shelby Sessions

[email protected]