Health Insurance Industry Issues and Legislation

Improper coding practices may well be costing commercial and government payers billions of dollars a year. Sutter Health has agreed to pay the federal government $90 million to settle allegations that it submitted inaccurate information on some of its Medicare Advantage (MA) beneficiaries. The settlement is the latest in a crackdown the federal government is instituting over MA coding that can contribute to overpayments. It comes less than a week after a major $575 million settlement was finalized on allegations the health system overcharged patients. HHC Group is here to help with claim and medical record level DRG Validation to root out costly coding errors before the claims are ever paid.

HHC Group offers a free pre-screen to determine if potential savings are significant enough to justify an in-depth line item review. When they are, highly qualified, experienced nurse coders scrutinize every line on the claims to identify the errors, large and to ensure only the appropriate amount is being paid. And if the provider challenges any of the edits, we provide appeal support from day one at no extra charge.

HHC Group's Health Plan GPS (HPGPS) is a user-friendly mobile app and website for member engagement and communications, two keys to the ongoing success of any Reference-Based Pricing (RBP) plan. We give you the tools to engage with members and reduce both plan and member healthcare costs. Contact us to learn more.