December 7, 2015

Dialysis Case Studies

These are actual cases GTSN has worked.  Remember that provider charges vary across the country and from patient to patient in dialysis based on the exact services each patient receives each treatment day.  As we like to say, “Percentage off what?

$554,000 annual savings estimate on out of network case previously paying billed charges
Transplant Network referred a case to GTSN paying billed charges with no discount. Through GTSN review determined and confirmed payments were all in error as the patient had no out of network benefits. Negotiated to go forward daily rate and group is recouping against incorrect out of network payments. GTSN negotiation keeps the case under the stop-loss spec.

$453,000 annual savings (71%) with provider sign-off Referral for a patient already treating with GTSN contracted provider. Confirmed our contract would be applied going forward and saved the group just under a half million first year.

$560,000 annual savings estimate on new contracted dialysis case
TPA contacted GTSN about a group with a dialysis case just starting. GTSN worked with the provider to obtain sign-off and no balance billing to patient at a healthy daily all-inclusive rate that worked well for both payor and provider. Life-sustaining dialysis care is still expensive, but now at a price point the payor can manage.

62% Average Savings ($320,000) on single case
Stop loss referred this case to GTSN upon notification with a lesser discount using plan assets quickly.  GTSN has a contract for a daily all-inclusive rate in place with the provider that the group was able to access through our National Dialysis Network.  The provider was notified of the change in networks and is still receiving a profitable and agreed upon reimbursement and the client is conserving funds as they are required to do.

$1.1 million saved in over-billing error
GTSN manually reviews each claim for every case before re-pricing.  Our claim team caught a large error caused by a provider charge master change that created over-billed charges for a common drug.  A call to our contact at the provider office and they corrected their system and our claims!

$505,000 savings on contested UCR payments
Claims for 2 cases had been paid at a low amount without provider sign-off.  When the provider escalated the matter to legal action GTSN received a call from the payor and carrier asking for help.  GTSN was able to resolve the payments with provider sign-off saving the client half a million plus on these two cases, as well as potential legal fees.

$1.7 million savings on stop loss case TPA held for a year
A stop loss client contacted us about a case one of their TPA’s had been holding for a year trying to figure out how to cut costs.  GTSN’s review found $679,000 in duplicate billings and then we were able to negotiate a large settlement on the proper charges.

$372,000 projected savings for plan looking for secure savings
A TPA approached GTSN about a self-funded client that was uncomfortable with the risks of Medicare Plus plan benefit reduction programs. They wanted something with good savings, but security.  GTSN was able to negotiate daily all-inclusive rates for the employer and they will save close to $400,000 in the first partial year. They now have the security of provider sign-off to guarantee the savings and no need to change plan benefits that would impact all their employees with potential balance billing.

Questions about how GTSN can help you or your client with dialysis cases? Contact Polli Yount at 615.712.6289 or yountp@gtspecnet.com

Click here to download a Referral Form to submit your case.