Health Decisions has been conducting enrollment audits for over 15 years. In the old days, these audits focused almost exclusively on coordination-of-benefits issues. The reality then was that families had “extra” coverage, and employers needed to sort out who paid first. Today, while we still find some coordination issues, COB levels are greatly reduced. Most audits now focus on confirmating that only eligible people are covered. This shift in enrollment reality has been caused by a number of factors.

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A growing number of companies are having their insurance rolls audited to ferret out cost savings in everything from unauthorized dependents to double billing and missed Medicare payments.

To take advantage of that trend, West Bloomfield-based Health Advantage Co. has teamed up with Plymouth-based Health Decisions Inc. to market its auditing expertise nationally.

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Recovery of Overlooked Claims by Health Decisions Inc. Stops the Bleeding

For more than 15 years Health Decisions, Inc.’s (HDI) claim recovery service has routinely produced a positive return-on-investment for its clients. A review of 100 percent of claims in more than 23 payment areas identifies and recovers claims paid by clients’ plans that are not their responsibility.

In September 2002 Health Decisions, Inc. reported reviewing claims totaling $261 million for selected clients. Expert review investigated and discovered $13.8 million that could lead to recovery and HDI’s powerful software identified $76.7 million that could lead to recovery. Of the almost $90 million so identified, $9 million in claims were actually recovered.

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We’re declaring WARR on waste and abuse in health care. If you share responsibility for a self-funded group health plan or bear risk for health care costs, join the WARR.

WARR stands for:

Waste - Any money paid by your plan that was not its liability.

Abuse - Any party acting in a manner inconsistent with your plan interests.

Recovery - Payment to your plan for “waste” collections.

Resolution - Contracts, policies and procedures that protect plan interests from abuse.

WARR consists of Warriors and the WARR Machine

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The Medicare Secondary Payor (MSP) Program has resulted in an increasing number of employers receiving Medicare Demand Letters. With other finance revenues drying up, the federal government will do what it can to slow the drain on Medicare, Medicaid and Social Security coffers. So Medicare is becoming very aggressive in collecting money from other sources to reduce its own payables.

A worker older than 65 may be covered by the active health plan at his place of employment and still be drawing Medicare payments. If Medicare discovers that it has paid a claim to an employee covered by a private plan, that employer will receive a Demand Letter in the mail insisting that Medicare be reimbursed, with penalty, for the claim that should have been paid for by the company’s health plan.

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Cummins Bridgeway has retained McGraw Wentworth [Troy, MI] and Health Decisions, Inc. [Plymouth, MI] to conduct an audit of health plan eligibility and claims administration. A distributor for Cummins Inc., Cummins Bridgeway is based in New Hudson, MI and designs, manufactures, distributes and services engines, fuel systems, generation systems and other related products. As a result of the audits and expected operational efficiencies, Cummins Bridgeway anticipates reducing the cost of providing health care benefits for its 640 employees, located in Michigan, Ohio and Pennsylvania. Read the rest of this entry »

How to Peacefully co-exist with Medicare

Decades ago one of the worst pieces of mail a young man could receive was a letter from the U.S. Selective Service System containing a Draft notice - Uncle Sam Wants You! Today, one of the worst pieces a mail an employer can receive from the federal government is a Medicare Demand Letter - Uncle Sam Wants Your Money!

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Money flows when enrollment errors are corrected

Given the rising costs of health care and intensive competitive pressures in the market, self-insured employers, health insurance companies and HMOs are cutting costs and always seeking greater efficiencies in processing claims for healthcare services.

Many self-insured employers and payors believe that the best opportunity to generate additional income is to be more aggressive in health claim recovery, to be sure only claims actually owed are paid.

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Self-Insured Employers and Health Insurance Companies Benefit

A Plymouth company has positioned at technology’s edge so it can assist giant health care insurers and mid-size to large corporations improve profits by recovering money after insurance claims are paid.

Health Decisions, Inc. has the power to review claims already paid and find enough income in unpaid claims to produce up to a 10-1 return for clients.

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