Client Success Story: Maximizing Savings on ESRD Dialysis Claims

Overview

End-Stage Renal Disease (ESRD) treatment costs continue to rise, creating significant financial challenges for healthcare payors. This case highlights how H.H.C. Group's Reference-Based Pricing (RBP) services and savings opportunities helped to secure substantial cost savings on an ESRD dialysis claim for a 56-year-old male patient.

Unlike competitive approaches to cost-containment, H.H.C. Group offers a flat-rate pricing model of $300 per treatment, ensuring consistent, predictable costs and eliminating excessive provider charges.

Challenge

A healthcare plan faced an ESRD dialysis claim totaling $833,054.41 in provider-billed charges. Without strategic repricing, the plan risked excessive overpayment, impacting financial sustainability.

Solution

H.H.C. Group leveraged its expertise in Reference-Based Pricing (RBP) to reprice the claim based on Medicare benchmarks, securing a fair and defensible payment amount while protecting the patient from balance billing.

• Provider Charges: $833,054.41
• Repriced Claim Amount: $39,329.62
• Flat Fee for Dialysis Treatments: $300 per treatment, totaling $43,200.00
• Total Net Savings: $750,524.79 (90.1% reduction)

Results

By partnering with H.H.C. Group, the payor achieved:

• 90.1% savings on a high-cost ESRD claim
• Transparent, predictable pricing through a flat-fee model
• Protection against balance billing for qualifying patients

Conclusion

This case underscores the significant cost-containment opportunities available through H.H.C. Group's Reference-Based Pricing for ESRD dialysis claims. By implementing a flat-fee model and leveraging Medicare benchmarks, H.H.C. Group ensures financial stability for payors while maintaining compliance and fairness for all parties involved.

For more information on how H.H.C. Group can help you achieve similar savings, contact us today.