Presentation is loading. Please wait.

Presentation is loading. Please wait.

Cost Plus Plan Components. Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________.

Published byAnna Preston Modified over 8 years ago

Similar presentations

Presentation on theme: "Cost Plus Plan Components. Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________."— Presentation transcript:

1 Cost Plus Plan Components

2 Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________ Frequency100% Cost? Appeals -Provider Files Appeal -Full & Fair Review By Independent Expert _________________________________________ Frequency7% Cost?

3 Liability Exposure Balance Billing Law firm inserted between patient and provider. ________________________________________ Frequency50% Cost? Lawsuits Insurance policy indemnifies the Plan, patient, TPA and broker/consultant ________________________________________ Frequency0% CostRetention & Premium

Download ppt "Cost Plus Plan Components. Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________."

Similar presentations

Agenda Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges – What do they mean? Do we Pay.

Agenda Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges – What do they mean? Do we Pay.
Claims Follow-up Claim Status Balance Billing Appeals.

Claims Follow-up Claim Status Balance Billing Appeals.
LITIGATION MANAGEMENT – Effective Cost Containment 2002 Conference Branson, Missouri.

LITIGATION MANAGEMENT – Effective Cost Containment 2002 Conference Branson, Missouri.
ATTACK of the RAC How to prepare and respond to RAC audits.

ATTACK of the RAC How to prepare and respond to RAC audits.
How to create a sense of Urgency with Payers Presented to the Wisconsin Revenue Cycle Co-Op/AAHAM May 8, 2014 By Isaac S. Schreibman, Esq.

How to create a sense of Urgency with Payers Presented to the Wisconsin Revenue Cycle Co-Op/AAHAM May 8, 2014 By Isaac S. Schreibman, Esq.
U.S. P/C Industry Loss & LAE Reserves Weakening September 13, 2010 U.S. Property/Casualty – 2009 Loss & LAE Reserve Review.

U.S. P/C Industry Loss & LAE Reserves Weakening September 13, 2010 U.S. Property/Casualty – 2009 Loss & LAE Reserve Review.
Medicare OT 232 Chapter 10 Lecture 2 1OT 232 Chapter 10.

Medicare OT 232 Chapter 10 Lecture 2 1OT 232 Chapter 10.
The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association.

The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association.
Coping with Regulatory and Payer Demands to Practice PM&R Bruce M. Gans, MD.

Coping with Regulatory and Payer Demands to Practice PM&R Bruce M. Gans, MD.
All Coders—US Citizens working on U.S. Soil Important for HIPAA and ComplianceImportant for HIPAA and Compliance Dual certified within first year Including.

All Coders—US Citizens working on U.S. Soil Important for HIPAA and ComplianceImportant for HIPAA and Compliance Dual certified within first year Including.
Loss Reserving Anatomy of a claim 12/15/99 Auto accident 12/20/99 Insured reports accident to agent 1/7/00 Claim recorded 2/3/00 $10,000 reserve set 1/8/01.

Loss Reserving Anatomy of a claim 12/15/99 Auto accident 12/20/99 Insured reports accident to agent 1/7/00 Claim recorded 2/3/00 $10,000 reserve set 1/8/01.
Risk Management & Insurance

Risk Management & Insurance
Unit 8: Insurance Section 14.1 – Insurance Basics.

Unit 8: Insurance Section 14.1 – Insurance Basics.
Advanced, Quality, Medical Reviews. Founded in 2010, Avandé's quality of service is a direct result of the vast industry expertise and wealth of experience.

Advanced, Quality, Medical Reviews. Founded in 2010, Avandé's quality of service is a direct result of the vast industry expertise and wealth of experience.
The Basics Understanding Health Insurance Terms Jennifer Flory, HIA, CPIW, CGBA.

The Basics Understanding Health Insurance Terms Jennifer Flory, HIA, CPIW, CGBA.
Brad Esarey, Vice President of Sales Leading with Compliance: The Advanced Beneficiary Notice (ABN) Form.

Brad Esarey, Vice President of Sales Leading with Compliance: The Advanced Beneficiary Notice (ABN) Form.
Healthcare and Life Management Session: Health Insurance and You June 25, 2011.

Healthcare and Life Management Session: Health Insurance and You June 25, 2011.
What makes an Airline attractive to Insurers? Olivier Marre, SVP Aviation Insurance RAASI Conference Moscow December 9 th 2009 A member of the Max Capital.

What makes an Airline attractive to Insurers? Olivier Marre, SVP Aviation Insurance RAASI Conference Moscow December 9 th 2009 A member of the Max Capital.
1Page CAS Ratemaking Seminar Non-Medical Professional Liability Pricing Denise Olson, FCAS, MAAA March 13, 2001.

1Page CAS Ratemaking Seminar Non-Medical Professional Liability Pricing Denise Olson, FCAS, MAAA March 13, 2001.
Health Care 101 Understanding the Basics

Health Care 101 Understanding the Basics

Similar presentations

Ads by Google