DON’T MISS OUT! Whether you’re embarking on a new cost containment adventure in-house, or with the help of a vendor, most programs are not simple “plug and play” affairs. Those who head into the dark unprepared will undoubtedly find themselves spooked by what hides around the corner.
Are regulatory nightmares keeping you up at night? Just last week the federal government announced some gory changes to their regulations, sure to have a scary impact on reference based pricing. Nervous the path you’re headed down will lead to certain doom? Many are questioning how far they can go with dialysis carve-outs, without running afoul of the Medicare Secondary Payer Act. Are the tricks piling up, but no treats are in sight? The HHS has announced a scheme to crush skinny plans. If that isn’t enough to scare you straight, someone had better check for a heartbeat!
Now is not the time to explore the regulatory wilderness alone! If you are looking to create some sweet savings, join The Phia Group’s own CEO, Adam Russo, Sr. VP & General Counsel, Ron Peck, and other members of the legal team, as they review the hottest topics and biggest news to impact our industry in the recent weeks.
Don’t be left “holding the bag;” add this free webinar to your calendar; October 30 at 1 PM and fear no more!
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As new products, procedures and methodologies are adopted by health benefit plans, each change in claims processing must be preceded by a change made to the applicable plan document. Nothing – from reference based pricing to MEC/Skinny Plans – can be implemented unless and until the plan document is adjusted accordingly.
The Phia Group has developed the industry’s first and only plan document drafting program that combines the convenience of online software with the personal attention to detail expected from The Phia Group’s team of plan drafting specialists.
Join The Phia Group’s CEO, Adam V. Russo, Esq., as he and Senior Vice President and General Counsel (Ron E. Peck, Esq.), Vice President of Consulting (Jennifer McCormick, Esq.), and a team of expert plan drafting specialists discuss the Phia Document Management system, innovative plan design, and why it is especially relevant in light of changes we predict all plan documents will be required to undergo in the coming years.
As plan sponsors and administrators examine their benefit plans in light of recent legal upheaval, now is our chance to implement important cost containment mechanisms. While only some changes are “mandatory,” while the “hood is open,” why not look around and make some other improvements? First and foremost, but often forgotten, is coordination of benefits, third party liability and subrogation. ”Subro” is one item that must be set forth in writing, and flow cohesively between the plan, stop-loss, network, and administrative service agreement. How recovery efforts are handled, who gets what (and when), and other subro-related issues can tie the elements of a strong plan together, or create gaping chasms between partners.
While it is true that some network contracts restrict a benefit plan’s ability to audit claims – or as is more often the case, simply prohibits the benefit plan from doing anything with the information so identified; some contracts apply unrealistic deadlines and still others contractually compel payment of claims otherwise excluded by the plan document… There are key provisions plan administrators can use to limit or eliminate the negative impact of such provisions.
Whether you are a plan administrator or claims processor trying to determine eligibility of a claim, or a stop-loss carrier trying to determine whether a submission is reimbursable, how applicable provisions apply to specific facts make all the difference. From exclusions to definitions… from discretionary authority to applicable law… not only understanding what a great document says – but understanding those documents “mean” – is the difference between overpayments and financial stability. Join The Phia Group’s innovative leaders as they discuss the best and worst language, how it impacted real plans when theory met reality, and when we were forced to ask, “to pay, or not to pay?”
As has seemingly been the case for almost every year in the last half-decade, 2013 – like its predecessors – was a busy year for those of us involved with health benefit plans. The continued (bumpy) rollout of PPACA and efforts made by legislators, regulators, and attorneys – both at the State and Federal levels – handicapped us as we attempted to adjust our plans to meet the requirements of law, while maintaining cost effectiveness. Now 2014 promises to be as eventful, if not more so. Join The Phia Group as we review the biggest issues dealt with in 2013, the lessons learned, and what we expect to be dealing with in the year to come.
As with the Loch Ness Monster and Bigfoot, we have all long believed that Provider Network Agreements exist solely in myth alone, never to be seen by human eyes… until now! From legend to reality; The Phia Group has obtained many provider network agreements, gone through them with a fine tooth comb, and present to you their expert analysis. Wonder at the disparity between plan documents and contracts. Be amazed by the provisions you never knew could be turned in your favor. Most of all, learn of invaluable contract-based arguments you can use to support plan document enforcement. This is a webinar you will certainly not want to miss!
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Health Insurance Reform (aka Obamacare, aka PPACA, aka Healthcare Reform) has not enjoyed a smooth implementation. In fact, its birth has been quite turbulent. Are you surprised? Like many in our industry, The Phia Group’s CEO – Adam V. Russo, Esq. – as well as its Sr. VP & General Counsel – Ron E. Peck, Esq. – were not shocked to see the many issues developing in the law’s rollout, but even we have been impressed by some of the hurdles. From the “Pay or Play” employer mandate being delayed by a year, to a complete lack of guidance regarding the many costs, fees, and expenses of the law, join us as we – along with our special guest – The Phia Group’s legal counsel and VP of Consulting, Jennifer McCormick, Esq., analyze the volatile evolution of this controversial law.
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We are all familiar with the contractual restrictions, limitations, and prohibitions imposed upon independent benefit plans and third party administrators utilizing major PPO networks. Whether it is restrictive deadlines, an inability to negotiate directly with providers, a prohibition on audits, or an obligation to pay in accordance with terms you’ll never see, many have complained about the apparent inequity established by these contracts. Few, however, have analyzed the network contracts existing between major carriers and their own network providers. One might be surprised to learn that these major carriers and ASOs not only recognize the importance of these items, but assert these rights for themselves! Join The Phia Group’s CEO – Adam V. Russo, Esq. – as well as its Sr. VP & General Counsel – Ron E. Peck, Esq. – as they dissect contractual terms existing between carriers and their network providers, and share the realization that they know exactly what is important to you.
On July 31st at 1 PM EST, The Phia Group’s CEO – Attorney Adam V. Russo – and The Phia Group’s Sr. VP and General Counsel – Attorney Ron E. Peck – will address one of the most pressing issues facing our industry today – balance billing. In particular, they will discuss what benefit plan administrators can do to assist their participants and push back against this problem.
To maintain benefit program viability, employers are cracking down on excessive spending through auditing and implementing new methodologies, such as cost based reimbursement and Medicare pricing, in addition to traditional network policies. In this new environment, participants will be thrust into the fray like never before; exposed to the threat of balance billing.
Topics that will be discussed include, but are not limited to –
• When strict enforcement of the plan terms and preventing balance billing may not be harmonious goals
• Undertaking efforts on behalf of benefit plans to resolve disputes with providers so that participants benefit as well, compared to “patient advocacy”
• Providing support to participants facing balance billing by explaining why the payments were capped, describing the appeals process in detail, and providing arguments they can raise against the provider