BMI reaches new high in claim negotiations in 2016; 67 Percent Savings.
BMI uses multiple wraparound PPOs when our members receive care from out-of-network providers. We also audit the billing and coding of PPO claims to eliminate payments of invalid charges. The average discount received from wraparound PPOs like Multiplan, Coalition America, Firsthealth, OneCare, Preferred Community Choice, NPPN etc was 29% in 2016.
For the claims that BMI’s Nurse Reviewers audited or negotiated in 2016, the average discount was 67 PERCENT. It appears that two things account for this increase. 1) Providers are getting more creative and less accurate with their billing and 2) BMI is getting better and better at eliminating claims expenses for our clients.Posted in Uncategorized | Leave a comment Posted on May 18, 2011 by hanklindley
See this report on a diabetic client of BMI’s.
…It looks like this client is finally being compliant with her testing, meds and diet.
We have gone from a glucose reading of around 455 to 130’s and 140’s over the last week.
It looks at first glance we probably saved at least an Emergency Room visit.
She will be up for recertification for another thirty days.
Dialysis Expense Management
BMI is testing Out-of-the-Box techniques including Holistic treatment of Chronic Kidney Disease. When paired with creative benefit limits for Dialysis, BMI clients are spared from extremely high dialysis costs and increased exposure from Reinsurance lasers.
Diabetic and Heart Disease patients are being positioned for greater cost-containment and improved patient health. BMI is testing home monitoring equipment on our own employees at work to evaluate ease of use and effectiveness. Client companies are invited to stop by to see and use the monitoring system for blood pressure, blood sugar, weight, etc. which is monitored telephonically by expert disease managers.
More Audit Findings
BMI claims examiners and nurse reviewers are continually identifying trends in healthcare and costs. Recently, we are discovering a high error rate on the billing of intensive care rooms when intensive care was not delivered. Another new problem area is the extended observation time beyond 24 hours without classifying the patient as an inpatient. Patients actually go to a regular semiprivate room but are billed as outpatients, and at a higher hourly rate than inpatients.
Outpatient Surgery Centers now play a bigger part in patient care, but they can adversely affect Plan expenses. BMI is carefully reviewing these charges, especially when the center has physician ownership. We have denied up to 90 percent of the bill for exceeding Reasonable & Customary on some claims and we are counseling covered members about the potential for extra, unexpected out-of-pocket exposure.Posted in Uncategorized | Leave a comment Posted on November 30, 2010 by hanklindley
Dear BMI Client, November 23, 2010
It seems like some of the dust is settling as more Health Reform details have been written. Maybe it’s because we study it every day, but we feel as if we have a pretty good handle on the compliance requirements. Nearly all BMI clients will retain their Grandfathered Plan status and have to make very few changes in benefits or eligibility. The required changes for most Plans on their first renewal after September 23, 2010 are:
1) No pre-existing exclusion for children or spouses (persons under 19).
2) Eligibility for children, stepchildren and foster children up to their 26th birthday as long as they are not eligible for coverage through their own or spouse’s employer.
3) No dollar annual maximums on Essential Benefits (list is yet to be published).
To maintain Grandfathered Plan status, you must avoid the six prohibited items:
1) Elimination of substantially all of a benefit to diagnose or treat a particular condition.
2) Any increase in the percentage of contribution by the member after 3/23/10.
3) Increase in deductible of more that 15% plus medical inflation.
4) Increase in copayments by 15% plus medical inflation or $5.00.
5) Decrease in employer contributions for any tier of coverage or class of individuals by more than 5% below the period including 3/23/10.
6) Certain changes in annual limits.
Plans will have to give 60 days notice of benefit changes but that requirement does not go into effect until the Essential Benefits list and 4-Page Summary of Benefits format are published.
For Grandfathered Plans, the balance of PPACA changes will be required on the first Plan anniversary on or after January 1, 2014. Dental and Vision benefits are considered an integral part of the plan only if employees or dependents can not elect those benefits separately. If they are not an integral part of the plan, market reform provisions do not apply to that coverage.
BMI is providing all PPACA guidance at no expense to our clients. We are also offering additional governmental reporting compliance for Medicare and Medicaid Section 111. We will provide more details on that next week but have a Happy Thanksgiving!Posted in Uncategorized | Leave a comment Posted on October 26, 2010 by Admin
Benefit Management in partnership with AIM Healthcare Services has saved it’s clients over $20k in the first two months of implementation. Both BMI and AIM specialize in providing a unique, balanced approach of addressing billing and payment errors through expertise and knowledge of the billing and reimbursement process from both the provider and payor perspective.Posted in Uncategorized | 1 Comment
Health Reform is at the forefront of our client service these days, as we continue to monitor and digest the provisions that would affect our clients. All but one of our clients are maintaining their Grandfathered Plan status as we carefully limit changes in coverage.
Some provisions of the law still lack even interim details, while others have already been interpreted and revised by HHS.
For our Grandfathered Plans, the changes that we know must be made on the first Plan anniversary following September 23, 2010 are...