End of the Year Success Story..
A payer based in the western United States, had an out of area, out of network claim, in the east. The provider was located in the state of New Jersey, notorious for their high costs and reluctance to negotiate.
The bill received was $247,722.00 for an emergency admission with convulsions. The primary diagnosis of bacteria meningitis resulted in a 14 day admission and the primary procedure was a spinal tap.
Assent Medical Cost Management applied its proprietary formula which includes a Cost-Up Analysis. Assent's Cost-Up Analysis is based on the hospital's most recent cost to charge ratios which are reported to CMS (formally HCFA). Assent utilized its Cost-Up approach as a strategic arbitration tool when settling claims. The analysis indicated that the hospital was marking-up its charges by more than 600% above the hospital's publicly reported cost. The Cost-Up approach allowed Assent to use the hospitals own data to reach a fair, equitable, and transparent resolution for both the payer and provider. This claim was also reviewed by Assent's medical physician, who identified via a line by line review more than $20,000.00 in charges challenges.
This combination of the two strong defensible methods of review and analytics resulted in a 60% discount, where the provider accepted $100,000.00, as payment in full. The provider signed off on the settlement and the payment was made. . . saving the payer almost $150,000.00.
A success like this could be your success for your clients and your bottom line.
