Medical Cost Containment

Medical Cost Containment

Reimbursement for Excessive and Abusive Medical Claims

Ensures All Hospital Claims include True and Accurate Charges and Fair and Reasonable Prices

Our proprietary compliance reviews are based on rules and regulations as set forth by:

  • Uniform Billing Act
  • Social Security Act
  • Code of Federal Regulations
  • False Claims Act
  • National AMA and AHA Coding Guidelines

Why utilize Medical Cost Containment Services?

A single hospital stay can range from $100K to $1M or more. The margin for errors, overcharging, and cost padding – whether deliberate or not – are incredible.

“For Every $100M in Claims, we can return $5M – $20M to your plan’s bottom line”


Negotiation of Reduction in Claims

We partner with self-funded employers to assist in the effort of fiduciary responsibility sought by CFOs regardless of the size of the group. We contract directly with these employers to become their “second set of eyes” in the claims paying process.

Most employers utilize discounts available through their ASO carrier, TPA, or other managed care organization as their process of cost containment. We seek additional opportunities of savings by reviewing every health claim and reaching out to hospitals, facilities, and providers when the pre-negotiated discount is less than desirable or the member has received care from an out-of-network provider where NO discount applies. Years of experience, as well as our internal health claims data, provide the confidence for our knowledge-based negotiators to achieve a history of increased savings to every self-funded health plan.

Clients and partners are constantly seeking cost containment strategies to help their clients in the quest to save additional health claim dollars and we specialize in this very niche.

Medical Cost Containment reviews claims on the health plan to obtain reduction in claims paid, typically resulting in a 5% to 15% reduction of total claims.

Value Proposition: The health plan saves on claims costs incurred and only pays on a contingency basis.

Who Can Benefit? Any self-insured health plan.