Phia Group Media


Phia Group Media

Issue of the Year: Reference-Based Pricing and Balance-Billing

On December 28, 2015

In 2015 the self-funded industry evolved like never before. Innovative ideas spread like wildfire, as TPAs, stop-loss carriers, employers and brokers all over the country implemented new techniques to contain costs and secure the best results. Yet, the path to savings hasn’t been an easy one to travel.

All along, The Phia Group has worked with you to resolve thousands of issues – and by far, the most misunderstood, repeated, passion-inspiring issue has been reference-based pricing, balance billing, and the role of a fiduciary when handling such an arrangement.

Thank you for joining The Phia Group’s legal team on December 15th as they discussed reference-based pricing and balance-billing from the ground up and debunked common myths associated with it. This webinar will ended the year with a comprehensive primer on reference-based pricing and balance-billing, the rights of all parties involved, and what you can do to be proactive and successfully administer a reference-based pricing program.

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Keeping PACE With The Trends

On December 7, 2015

The self-funding industry is experiencing great opportunity and growth. In the past two years, millions of lives have transitioned away from the fully-insured health plan model in favor of the self-insured model – and despite the rise of exchanges, many employers are steering away from them for various reasons. These encouraging facts are tempered by the increased burdens facing both new and existing employer sponsors, third party administrators, industry brokers, and even stop-loss carriers and MGUs.

Fiduciary responsibilities have grown, liability shifting is now a common theme in a standard RFI, and lawsuits over claims and appeals decisions are becoming more prevalent.

Thanks for joining The Phia Group’s legal team on November 30th as we explored the numbers behind our industry’s growth and provided real-world discussion on the topic, while we explored real solutions to the issues presented.

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A Call To Action!

On October 15, 2015

All too often, we find ourselves comfortably observing change from a distance, allowing others to dictate our destinies. Today, various litigious matters are being presented to courts of law, regulators are issuing new rules, law makers are drafting statutes, and insurance commissioners are releasing bulletins that impact how we operate. Elsewhere, stop loss carriers, TPAs, plan sponsors, networks, and other entities that should be working in concert are instead working against each other.

Thanks for joining The Phia Group’s legal team on October 14th as we discussed many such ongoing instances, and shared with you opportunities to take an active role in the preservation of our industry.

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"Phia Case Studies" - When Silence is Loud and Assumptions Mean Disaster

On August 4, 2015

We’ve got the stories that will enable us all to learn from others’ mistakes, and see that “what we have here…is a failure to communicate.”

As employers look to self-fund with increasing frequency, expectations that brokers, vendors, and third party administrators will take on more binding authority are trending as well. Cases where an entity is held liable for failing to uphold a responsibility it didn’t intend to adopt are consequently on the rise as well. These recent cases impact how you are (or at least should be) handling claims.

Are you living up to expectations? Gaps in coverage and a lack of clarity expose you all to punishment and regulation.

Thanks for joining The Phia Group’s legal team on September 17th, at 1:00 PM EST, as they analyzed recent cases featuring communication breakdowns, regulation popping up in its wake, and best practices to make sure you know your role and do your job.

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"Stories From The Front Lines" - Real Wins, Losses, & Difference Makers

On May 20, 2015

Join The Phia Group on Wednesday, May 20th, from 1 to 2 PM EST, as its attorneys discuss their experiences providing plan administrators with guidance as it relates to difficult claim processing decisions, conflict resolution, and bill negotiation… as well as dissect the small factual differences between otherwise similar scenarios that made all the difference.

These are our Stories from the Front Lines.

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"Survival of the Fittest" - Best Practices to Perfect a Modern TPA

On April 23, 2015

Join The Phia Group on April 23, from 1 to 2 PM EST, as they discuss best practices and new methodologies TPAs are considering, in their quest to remain relevant in a modern healthcare arena. Covered topics will include innovative services, products, and processes being used today, and developed for tomorrow. The Phia Group will identify both the issues and solutions that seem to be spreading, and how proactive administrators are addressing both.

Join The Phia Group’s legal team as they discuss the best practices for TPA’s and how this can help you!

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"To Be Or Not To Be"... A Fiduciary - Do You Even Have A Choice?

On March 25, 2015

Being a fiduciary is serious business. Determining whether you are one can also be very complicated. Case law increasingly establishes that being a fiduciary has more to do with the action one takes, than the contract one signs. Entities working on behalf of self-funded benefit plans may be unknowingly taking on fiduciary status. Are you a fiduciary? What are the advantages and disadvantages of taking on that burden? What can you do to protect yourself?

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Pushback & Counter-Attack

On February 12, 2015

Pushback & Counter-Attack – How attorneys, providers, and the government are combating your efforts to contain costs… and what you should be doing about it!!!!

ERISA has been a target of scrutiny since its passage. Rights to subrogation, coordination of benefits, audit claims and enforce plan provisions – though pillars of cost containment – are constantly attacked. Attempts to prudently manage plan assets, though required by federal law, are met with pushback at every level. Now, with the passage of PPACA, old and new methods to maximize plan benefits and minimize costs are challenged. Join The Phia Group’s team of attorneys on Thursday, February 12th at 1PM as they discuss the hurdles we face, both old and new; and what we can do to not only survive, but thrive in the face of such adversity.

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On January 14, 2015

IMPLANT WARS: How monitoring provider self-referrals, & negotiating based on actual costs can result in major plan savings!

Those who fail to identify ways to separate themselves from the pack through new, innovative cost containment processes will be left behind. Yet, even the most diligent administrator feels powerless in the face of excessive costs, finding it nearly impossible to negotiate claims with providers, or apply reasonable and appropriate pricing. Thriving requires tackling you plans’ biggest cost drivers; but how can you carve out, monitor, and negotiate “the big claims?” Kick-off the new year by joining The Phia Group’s CEO, Adam V. Russo and his legal team, as they discuss this important topic and introduce you to their newest offering; Implant Cost Pro! This is a webinar not to be missed.

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"In Reference To The FAQ"... The DOL FAQ Dissected - Part Deux!

On November 20, 2014

On October 10, 2014, the Department of Labor, in conjunction with other regulatory agencies, released its “FAQ XXI.” In response, during its October Webinar, The Phia Group tore through the FAQ, sharing its concerns regarding the FAQ’s questionable verbiage and provisions. The support shown for The Phia Group’s October Webinar, “Creeping Around Pitfalls on the Way to Scary Savings! – How to Avoid Horror When Implementing Cost Containment Schemes!” was overwhelming! Not only did we enjoy an incredible turnout, but our attendees responded by providing some thought provoking insight to consider. Many of our industry’s greatest minds have since joined The Phia Group in assessing the FAQ’s meaning, impact, and steps we need to take to continue down the path of Reference Based Pricing. In November, we will share these ideas and conclusions with you.

Join The Phia Group’s CEO, Adam V. Russo; Sr. VP & General Counsel, Ron E. Peck; and other members of the legal team as we continue to dissect the FAQ, its key provisions, and how it impacts “RBP Plans .

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