Where we’re going

Today, employer-sponsored health plan administrators benefit from billing partnerships that offer software and data-driven solutions. Real-time price information regarding the true cost of care enables plan sponsors and members to make the most advantageous cost-benefit decisions regarding care options. The right medical billing partner will be an agent of change, embracing innovation and advocating for … Continued

Currently, there is a lack of medical billing price transparency throughout the U.S. healthcare industry. According to an article now published in USA Today, a study finds few hospitals are meeting new federal transparency requirements, yet only two have faced fines. Starting January 1, 2021, price transparency rules require health systems to publicly post the … Continued

In the bottom of the ninth inning of a baseball game, score tied, bases loaded, two outs, everything on the line, a pitcher may decide to unnerve the hitter at the plate with a “brush back” pitch – a high and tight fastball. Very dangerous. Here, DaVita had “brushed back” Marietta (and perhaps all other … Continued

In May, AHIP and the Blue Cross Blue Shield Association (BCBSA) announced the results of a study and analysis regarding the impact of the No Surprises Act (NSA). The survey defined a surprise medical bill as: Treatments by non-network providers that fell under the expanded definition of emergency services (including post-stabilization care) Non-emergency services by … Continued

Employers with a calendar year benefit plan year should begin preparing for annual enrollment starting now.   We are experiencing a period of rapid cost inflation and expect renewed, higher levels of health care cost inflation to soon follow. This comes as a large segment of Americans are already financially fragile – unprepared for regular … Continued

In the fifth and final webinar session of Humaculture, Inc.’s Hidden Opportunities, Strategic Compliance series, Jack Towarnicky, a member of aequum, confirmed how plan sponsors can lower costs and manage risk exposure through a more strategic approach to the new annual fee disclosure requirements. A focus on compliance might simply accept whatever disclosures are received. While … Continued

In the fourth of five webinar sessions, Mental Health Parity – A Lucid Approach, Jack Towarnicky, a member of aequum, joined industry professionals from Humaculture to identify the new mental health compliance requirements and to discuss why mental health issues, costs and administration continue to increase despite the 25+ year old promise of Mental Health … Continued

May is Mental Health Awareness Month. The National Alliance on Mental Illness (NAMI) reports that in 2020 one in five U.S. adults experienced a mental illness, one in fifteen experienced both a substance use disorder and mental illness, and one in twenty experienced a serious mental illness. The COVID pandemic has increased mental health issues … Continued

Part 2 of Adopting a “Pure” Reference-Based Pricing Strategy The No Surprises Act (NSA) covers all participants in employer-sponsored health plans. It’s goal is to protect participants from surprise medical bills for charges in excess of negotiated rates with network providers. The NSA applies to emergency services as well as care received from out-of-network providers at … Continued

aequum is mindful that government agencies adopt regulations that may extend the reach of or may conflict with the original text of the legislation. This update provides an overview and recent legal challenges to a portion of the law. According to research by the Kaiser Family Foundation and others, about 1 in 5 emergency department … Continued