Resources
No Surprises Act
In a bipartisan effort to end balance billing, the No Surprises Act was written into the most recent coronavirus relief package. “Balance bills” are bills…
6 Questions About Making the Switch to Reference Based Pricing
Healthcare costs continue to increase annually at a rate far above the national cost of living percentage. Health insurance is one of the largest expenses…
My Journey From BUCA to ClaimDOC
The US healthcare system provides an undeniable quality of care, technology, and providers. Yet, these providers are disconnected from the member by a maze of…
Looking Back and Going Forward
As we look back at 2020 from a business perspective, it’s almost mind-numbing to summarize the meaningful events that unfolded. Ultimately, I’m so proud that…
COVID-19 billing observations and information
We released an Audit Spotlight in our last newsletter related to a COVID-19 claim. The claim example generated many questions from the brokers…
Member Education, the key to a successful RBP program
Education is the basis of a successful health benefits experience, especially when it comes to reference-based pricing (RBP). Creating a robust year-round education program that…
Renewal season is upon us
If you think you will flatten renewals this year, you should reconsider. While it is true COVID-19 held utilization down to levels unseen for almost…
New price transparency regulations
Healthcare-related costs continue to soar. The number of patients who are surprised when they receive an astronomical bill for a covered service is also growing…
Full Network Replacement
Traditional program structure for reference-based pricing has included a physician-only network coupled with a vendor capable of auditing and applying revised pricing to facility claims.