A Few Hard-Dollar Savings Cases and Testimonial Examples
We appreciate that each organization or non-profit with whom we work, is truly unique. We have a 93%+ success rate at implementing tailored solutions that positively impact Net Income. It’s highly probable, your organization can increase your bottom-line while simultaneously making positive social impact.
With Hard-Dollar savings solutions, we work primarily on a contingent-performance basis. Thus, we only get paid when our teams create new, measurable Net Income. This approach mitigates your organization’s financial risk and puts you in a cash-positive position, since the contingent-performance fee is coming out of the new monies our teams create in collaboration with your organization. Regardless of which Net Income increasing services are delivered, the organization keeps the majority of the new monies created.
Below are a few examples from our case studies to provide a flavor for what can be achieved at Fortune 500’s through mid-sized organizations.
The 100% Difference – Every Claim $, Every Possible $ – Healthcare Self-Insured Audit Summary
Many employers choose to self-insure their employees’ medical expenses to save money and maintain greater plan control by having a third-party administrator (TPA) manage claims processing. Our team’s comprehensive audits, review every (this is the 100% difference) healthcare claim to identify over-payments for recovery and correct systemic claims-processing errors for long-term savings.
We make it right by finding the source at the root cause and correcting the problems.
- Our team’s No.1 priority is your company’s financial interest. Our expertise works for you.
- Our team’s expert data review process triggers creation of custom queries for “best probable error” selection, identifying more systemic errors and leading to increased future savings.
- Our team makes it simple by doing most of the work, keeping you up-to-date along the way. It is our team’s job to take a closer look, so you don’t have to and you can focus on your core business.
- Low risk. High return. We offer customized, flexible pricing options designed to meet your needs and accommodate your TPA’s requirements. The return is more recovered dollars for your bottom-line.
Important: This comprehensive audit helps satisfy your fiduciary responsibility. Performing an annual healthcare claims audit protects your financial interest and fulfills the duty of care for your stakeholders, ensuring their trust and confidence.
100% Comprehensive (vs. Random) Audit for a Self-Insured Employer – A key state on the East Coast is actually on the leading edge of managing healthcare costs. In fact, they are going to start contracting directly with providers.
Our team was able to win this large account due to our long, successful track record with a Fortune 10 (ten) corporation over the last 13+ years and some very detailed examples we were able to discuss during our presentation. This is a new account and we anticipate the savings to exceed $10M over the next three years.
100% Comprehensive (vs. Random) Audit for a Self-Insured Employer – One of our team’s largest individual claim recoveries involved a ground ambulance claim originally paid at $700,000 and the claim should have been paid at approximately $2,000.
.
Two factors contributed to this overpayment. An ambulance claim involves two components; a base rate and a charge for mileage. Base rate is billed at a unit count of 1 and the mileage is billed with the number of miles. In this case, the claims were incorrectly billed with over 100 units of the base rate, which in fact was the number of miles.
.
Secondly, the TPA incorrectly considered the ambulance provider as in-network with a contract rate of 100% of billed charges. In fact, an out-of-network limit should have applied as well. The claim was eventually corrected with $698,000 returned to the client’s bottom line.
Fraud and Abuse
100% Comprehensive (vs. Random) Audit for a Self-Insured Employer – Unfortunately, fraud and abuse is prevalent in healthcare. We recently discovered a pattern of abusive billing by an out-of-network ambulatory surgery center used by one of our clients. As an example, the facility billed over $600,000 for a one day outpatient surgery.
.
Our team was able to show that the in-network physician who performed the surgery actually had ownership in the ambulatory surgery center and had referred the patient to that center. The negotiated payment of several hundred thousand dollars is still under review by the TPA. Future claims for this facility are now automatically suspended on behalf of our client.
Profit Siphon Elimination Services Summary
.
By leveraging knowledge and experience acquired during careers on the vendor side of the negotiating table, we identify and recover profit dollars leaking unnoticed from your bottom line.
Hundreds of thousands of lost profit dollars are recovered for you, which can be redirected to better assist your revenue and profit goals.
Over 93% of the companies we speak to have significant profit leakage. Because most companies feel they don’t have leakage, we create a customized report, without cost or obligation, to show you where it’s hidden. And then, without disrupting your focus or workflow, we recover the lost profit dollars outlined in your custom report.
There’s NO upfront cost and we’re performance based. Hard-dollar results are delivered before you invest a single cent!
For those clients who are extremely skeptical there really is profit leaking unnoticed from your bottom line, we created the “$1K Either Way” guarantee to confirm the accuracy of the profit leakage identified in your report. If your profit recovery doesn’t meet or exceed what’s listed in your report, we’ll make a $1,000 donation to your favorite charity. Which we’ll also do after recovering the profit leakage figures which have been “guaranteed” in your report. Hence the name $1K Either Way”.
Process Improvement Case Study
100% Comprehensive (vs. Random) Audit for a Self-Insured Employer – By rule, Medicare is generally primary for COBRA participants who are age 65 and older. In other words, employers only have secondary liability for healthcare claims.
.
A recent audit revealed a large volume of claims incorrectly paid as primary by our client on this issue. As it turned out, the TPA was relying solely on responses to Other Insurance Questionnaires to its membership to determine the existence of other primary coverages. The response rate to these mailed questionnaires was less than 5%.
.
Based on our findings, the TPA now automatically contacts Medicare to determine applicable coverage for all members on COBRA age 65 and higher. In addition to root cause correction for any future overpayments, we were able to identify over $1 million in recoveries for this client.
Process Improvement Case Study
100% Comprehensive (vs. Random) Audit for a Self-Insured Employer – A recent trend to reduce healthcare expenses is for plan designs to limit out-of-network exposure. A common example is to place a maximum plan allowed amount for out-of-network based on a percent of the Medicare fee schedule rate. On a recent audit for a modest-sized media company, our team found that all out-of-network claims were paid incorrectly at full-billed charges. In addition to an immediate return of $500,000 for historical overpayments, the TPA made systemic changes to accurately process out-of-network claims moving forward.