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New cost-containment approach can prevent high-cost, surprise medical bills and save payer millions

March 17, 2016 H.H.C. Group Introduces Precertification For Employers Using Its Medicare-Based Pricing Service GAITHERSBURG, Md. March 17, 2016 H.H.C. Group, a leading healthcare cost-containment company that works on behalf of insurers, including self-insured employer groups, announced today it has introduced a new component to its Medicare-based pricing service to prevent payers and health plan members from facing exorbitant prices for certain medical procedures. Using its new precertification option, H.H.C. contacts hospitals when plan members it represents require certain procedures or treatments oftentimes before these patients are admitted to the hospital. In these circumstances, H.H.C. seeks to agree upon a price for the required treatment using rates set by the Centers for Medicare and Medicaid (CMS) as its benchmark. As a result, the new price is often tens of thousands of dollars less than the hospital's list price.

H.H.C.'s Medicare-based pricing service, also known as reference-based pricing, uses government-set Medicare rates as a benchmark, and the payers H.H.C. represents agree to pay a multiple of those Medicare rates. The approach adds a degree of transparency and reasonableness to the pricing structure and largely ignores the rates set by hospitals rates that may be wholly arbitrary and incongruent with competitors in the market.

The health plans H.H.C. works with and those plans' administrators can choose to apply the precertification option only to services provided at out-of-network facilities. Or for plans that use Medicare-based pricing for all claims, they can choose to use the precertification option for services that exceed a certain dollar threshold. In both scenarios, H.H.C. prospectively contacts the hospital and pre-negotiates the cost of the service. This "before-the-fact" approach to pricing ensures that patients won't end up with a bill that far exceeds anticipated costs. Moreover, it gives patients and their insurers the opportunity to identify alternative providers if the first hospital is unwilling to deliver care at a specific rate.

"Without negotiation by H.H.C. Group, our clients and the plan members they cover could face sky-high costs for their health care," said Bruce D. Roffe, P.D., M.S., H.I.A., President and CEO of H.H.C. Group. "Our new precertification option offers peace of mind, and it protects our clients and the men and women in their employ while offering unparalleled flexibility."

Since H.H.C.'s precertification service requires setting prices prior to the delivery of care, patients can effectively "shop" from a wider range of hospitals and providers without the limitations imposed by narrow networks. This gives them greater flexibility and access to more healthcare options. In this regard, H.H.C. Group is currently exploring new provider selection opportunities that would give plan members and their insurers information about prices available at other hospitals.

"Precertification is a cost-control measure that protects both payers and members," said Robert Serber, special projects manager of H.H.C. Group. "Rather than controlling costs exclusively through pre-negotiated reimbursement rates for network providers, our precertification strategy using Medicare-based pricing expands our clients' options. Now, members may choose almost any hospital at an affordable, reasonable price. It's a significant development toward providing healthcare consumers with greater latitude and eliminating undue cost constraints."

For Immediate Release
Media Contact: Meieli Sawyer
(305) 668-0070

About H.H.C. Group

H.H.C. Group is a nationwide, healthcare cost-containment company that works on behalf of insurers, including self-insured employer groups and the third party administrators that handle their health benefits, as well as ERISA and government health plans. For more than 20 years, H.H.C. has helped these organizations reduce healthcare costs through a continuum of services including medical claims negotiation, re-pricing, and medical bill review. In addition, H.H.C. is accredited by the URAC (Utilization Review Accreditation Commission) to provide independent peer reviews for medical claim grievances and disputes in certain states.