Biden Administration Releases New Guidance on QPA Calculations and Reopens the Portal for New Disputes
Claritev summarizes the FAQ issued by the Biden administration on October 6, 2023 as well as the reopening of the IDR portal.
-
-
Tackling Out-of-Network Medical Bills with Data iSight
To tackle the problem of out-of-network charges, Claritev developed our Data iSight pricing methodology. Unlike Usual and Customary (U&C) or Medicare-based repricing solutions, our methodology recommends reductions using both a cost-up approach (for facility claims) and median reimbursement levels (for practitioner claims) to achieve maximum defensibility, wide provider acceptance, and savings of 61%-81% off billed charges.
-
Use of the IDR Process to Settle NSA Disputes Is Greater Than Anticipated
A little more than a year after launching the No Surprises Act’s Independent Dispute Resolution Portal, the Departments of Health and Human Services (HHS), Labor, and Treasury gave an update on the federal IDR process for the period from April 15, 2022 through March 31, 2023. Claritev highlights the findings.
-
MedCity News: The Promise of Healthcare Pricing Transparency
Healthcare is a major expenditure for employers and employees, yet Americans purchase it without insight into price or quality. Medical costs contribute to 66.5% of household bankruptcies—lack of transparency is a contributing factor. Employers, payors and providers should consider alternative models of care such as value-based plans with built-in access and transparency.
-
The Texas Medical Association Challenges the IDR Fee and Batching Rule in Its Fourth NSA Lawsuit
MultiPlan summarizes the Texas Medical Association’s fourth NSA lawsuit, challenging the IDR fee and batching rule.
-
Healthcare Business Today: Healthcare Payor Trends to Watch in 2023
As we look forward to the new year, we will see payors, providers, and consumers collaborating to improve the healthcare experience. One thing is a sure bet, healthcare will remain a dynamic industry with creative solutions emerging throughout 2023 and beyond.
-
Payment Matters Podcast: Price transparency and the relationship between price, quality and healthcare
Ryan Day breaks down the current healthcare benefits landscape on the Payment Matters podcast with Jeff. Lin. Listen to learn how reference-based pricing as part of a value-driven health plan services gives employers the power to control rising employee healthcare costs.
-
Should reference-based pricing be part of your healthcare benefits this year?
Americans are concerned about rising healthcare costs, and among the insured, almost half worry about covering their deductible. With the cost of employee benefits projected to rise, employers and employees are looking for ways to lower costs. Ryan Day, President of HST, a Claritev Company, outlines ways reference-based pricing provides value, transparency, and quality in employee benefits.
-
Pre-Payment Negotiation Is Beneficial to Payors and Providers in Settling Surprise Bills
The August Final Rule clarified that arbitrators need to consider QPA along with other factors such as provider experience and severity of the patient’s illness. Claritev explores whether this clarification means payors should consider adjusting the strategy they use to process surprise bills.
-
Stabilizing the Unsustainable: A Look at the Healthcare Market in 2022 and the Stabilizing Power of Reference-Based Pricing
When employees and employers think of healthcare, adjectives like, “expensive” and “costly” may come to mind. Health systems, policy analysts, and other healthcare experts agree. They’ve labeled the rising costs in U.S. healthcare as unsustainable.