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
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For those that are invested in maintaining health benefits, inventing new cost saving methodologies is the “holy grail.” Enter the provider – hospitals, physicians, and other health care facilities. From specialty networks to direct provider negotiations; from medical tourism to ACOs… The way we receive care is changing. While some providers embrace the opportunity to shake things up, others cling to the status quo. Conflicts inevitably result from such changes, including: contract disputes, provider appeals, audits and refund requests… Join The Phia Group’s CEO, Adam V. Russo, Esq. as well as its Senior VP and General Counsel, Ron E. Peck, Esq., as they confront these and other provider conflicts on the rise.
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In a world dominated by reform and regulation, there are those who master compliance and thrive, and those who stumble under the burden. Thriving in the post PPACA era requires innovation, and a proactive attitude. Predicting what mandated benefits will be required from your benefit plans, discovering the most cost effective methods to maintain a benefit program and thereby “play” rather than “pay,” and other issues haunting every member of the industry will be discussed. Join The Phia Group’s CEO, Adam V. Russo, and Sr. Vice President, Ron E. Peck, as they share the secrets of regulatory compliance success.
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As time passes and elements of PPACA are triggered, the cost of purchasing insurance has become too great. Meanwhile, employers see an opportunity to drop coverage, pay a relatively small penalty, and exile employees to the exchanges. The reasons to offer employment based benefit plans hasn’t changed. For those that self-fund, they need to know why self-funding remains the best option for them. For those leaving fully funded insurance, self-funding may be an option they haven’t considered. Join The Phia Group’s CEO, Adam V. Russo, and Sr. VP, Ron E. Peck, as they discuss the many reasons to keep health benefits in-house, and how self-funding allows employers to “play” the game in a PPACA era!
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The survival of self-funding in the face of PPACA, stricter stop-loss regulation, and the exchanges, is reliant upon doing more for less. Plan administrators are now thinking outside the box, developing payment methodologies that draw upon both old and new practices. Change, however, invites upheaval; in a world dominated by PPO networks and provider agreements, anyone who strays from the norm has a fight on their hands. Join The Phia Group’s CEO, Adam V. Russo, and Sr. Vice President, Ron E. Peck, as they dissect these new concepts, consider the pros and cons, and share their experiences as advocates of these new theories.
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In May of 2012, the California Workers’ Compensation Appeals Board (“WCAB”) adopted amendments, which impact the ability of lien claimants to obtain recovery.
• To secure reimbursement when filing a “green-lien,” lien claimants must pay a fee of $150.00.
• To secure reimbursement when filing a “green-lien,” “…lien claimants must appear at a lien conference and/or trial …”
We have already developed a strategy to ensure a smooth progression in light of these rules, and have the legal expertise in place to secure recovery. Please note, however, that the filing fee and appearance by local counsel will result in additional expense to the Plan. In an effort to maximize recoveries for our clients while minimizing costs, The Phia Group and its clients will have to conduct a cost-benefit analysis when deciding whether to pursue reimbursement, on a case by case basis.
PLEASE MARK YOUR CALENDAR! The Phia Group will be hosting a webinar specifically regarding these issues on January 23, 2013 at 4 PM EST / 1 PM PST. We have limited invitations to you and entities like you, directly impacted by these new rules. We will be discussing the new rules in greater detail, will field your questions, and will discuss the many issues benefit plans should keep in mind when assessing their options. It is important to us that you attend.
The Phia Group’s CEO (Adam V. Russo), Sr. VP and General Counsel (Ron E. Peck), and resident subrogation litigation expert (Christopher Aguiar) will delve into current events, litigation, and changes in law (official and otherwise), as they share the current state of affairs for anyone and everyone interested in subrogation. You may think your time-tested methods for cost containment via claims recovery are safe and sound… and you’d be wrong. This is a discussion you will not want to miss.
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If you thought 2012 was a wild ride, wait until you see 2013. Obamacare is the law of the land, and it’s here to stay. The entities empowered by PPACA to issue mandates are prepared to unleash a tidal wave of regulations in 2013. Subrogation and coordination of benefits once again appear before the Supreme Court. The very definition of self-funding, rights under ERISA, and access to stop-loss have come under attack. Join The Phia Group’s CEO, Adam V. Russo, Sr. V.P. and General Counsel, Ron E. Peck, and V.P. of Consulting Services, Jennifer McCormick, as they discuss what we can expect to see in 2013, and how best to prepare for what’s coming.
Mitt Romney has been distancing himself from the healthcare reform he signed into law whilst governing Massachusetts. His team has responded to comparisons between “Romneycare” and “Obamacare,” stating that the two laws are vastly different, and vary based on scope of coverage, communities they apply to, and terms themselves. That being said, we can still draw many parallels between the two. Those of us who fail to look at the Bay State as a prototype for post-PPACA America are missing an opportunity to gaze into the future. From early successes, to a gradual bloating of the program… from red-tape, to recent moves to address the actual cost of care… the Commonwealth of Massachusetts is certainly a crystal ball. Join us as we dissect The Phia Group’s home state, and attempt to predict the nation’s future.
Plan sponsors are looking for ways to cut costs without limiting benefits. New solutions are popping up everywhere, from medical tourism, to carving out dialysis; from placing a Medicare + cap on allowable expenses, to having outside auditors reprice claims. The industry is shifting from a pure PPO focus, but with change comes uncertainty. Believe it or not, but these programs present risks along with rewards. Conflicts with providers, balance billing, accusations of discrimination, stop-loss denials, and other negative repercussions are only some of the “tricks” we will help you avoid as you seek to indulge in the newest, innovative “treats” our industry has to offer.