Medical Overbilling is Costing You Billions
As healthcare costs continue to surge, payors, TPAs, self-funded employers and stop-loss carriers are facing unprecedented challenges in controlling high-cost claims. Industry data shows that claims exceeding $1 million have increased by 45% since 2019 and projections indicate healthcare premiums will rise another 8% in 2025, marking the highest increase in a decade.
To help organizations navigate these escalating expenses and growing regulatory complexity, H.H.C. Group has released its latest white paper. Managing High-Cost Healthcare Claims: A Comprehensive Approach to Cost Containment and Efficiency. This timely resource delivers valuable insights and actionable strategies designed to contain costs, ensure compliance and improve operational efficiency.
Healthcare budgets today are under increasing strain as high-cost claims continue to escalate, driven by multiple, compounding factors. At the forefront are conditions such as cancer, cardiovascular disease, autoimmune disorders and neonatal care—each consistently ranking among the most expensive contributors to overall medical spending.
Adding to this financial pressure is the relentless rise in specialty drug costs. These drugs now account for more than half of total prescription drug spending, with some therapies exceeding $1 million per patient annually. The financial burden doesn't stop there. Advanced procedures, including organ transplants and complex surgeries, along with ongoing management of chronic conditions, further complicate claims and inflate costs.
Beyond the direct medical expenses, regulatory requirements like the No Surprises Act introduce additional layers of administrative complexity. Compliance with these evolving mandates requires constant vigilance, increasing operational burdens on healthcare payors and plan sponsors.
Smaller organizations are especially vulnerable, as a single catastrophic claim can destabilize budgets and threaten financial health. Even larger entities, though more insulated, face rising stop-loss premiums and growing administrative challenges as they work to manage both costs and compliance demands.
H.H.C. Group's white paper outlines a comprehensive set of strategies tailored to the specific challenges payors, TPAs, self-insured employers and stop-loss carriers face in managing high-cost claims:
Focused approaches to mitigate the financial impact of oncology, cardiovascular disease, autoimmune disorders and neonatal care—conditions consistently driving the most expensive claims.
With some specialty drug treatments exceeding $1 million per patient annually, the white paper explores actionable strategies to control these costs, including negotiated discounts, biosimilar utilization and site-of-care optimization—all while maintaining care quality.
H.H.C. Group's attorney-led negotiation teams leverage proprietary data, regulatory expertise, and industry benchmarks to secure savings of up to 90% on catastrophic claims, in both in-network and out-of-network settings. Comprehensive bill reviews further identify errors, duplicates and inappropriate charges, preventing overpayments and eliminating unnecessary expenses.
URAC-accredited independent reviews ensure claims are medically necessary, accurately billed and compliant with regulatory standards. This dual clinical and financial evaluation supports defensible decision-making and reduces liability risks.
From the No Surprises Act to evolving state fee schedules, organizations must stay compliant amid shifting mandates. The white paper provides guidance on integrating cost-containment strategies like negotiation, reference-based pricing and fraud detection to align with these complex requirements.
Payment models benchmarked to Medicare rates provide consistent, transparent pricing. RBP minimizes provider disputes, mitigates overpayments and protects against balance billing while supporting compliance efforts.
Advanced analytics and audits powered by AI identify billing inaccuracies, duplicate charges and abusive practices. These tools, combined with regulatory expertise, ensure adherence to mandates and reduce financial waste.
For over three decades, H.H.C. Group has delivered measurable savings, operational efficiency and regulatory compliance. H.H.C. Group's integrated solutions are supported by:
Effectively managing rising claim costs requires more than generic solutions. It demands a focused, data-driven approach supported by regulatory expertise, technology and proven results.
By partnering with H.H.C. Group, organizations gain access to a comprehensive suite of tools that reduce healthcare costs, ensure compliance and strengthen financial sustainability.
Download H.H.C. Group's new white paper today and equip your team with the strategies to control costs and manage high-cost claims with confidence.
Maximizing Savings On Medical Claims
© 2024 HHC Group. All Rights Reserved.