Assent is a leading cost containment company with experience in the domestic and international markets, and specializes in solutions for in and out of network medical claims in order to control medical cost. Assent’s proprietary solutions are transparent and provide payers and consumers with assurance that their medical costs are true, accurate, and reasonable.
As payers move away from relying primarily on outdated cost containment practices, including PPO discounts and traditional negotiations, Assent’s unique approach brings all the parties together “to agree” to reimbursement terms which are favorable and equitable to all.
This proven and tested approach recognizes that providers are entitled to earn a profit and be paid in a timely manner for their services, but that payers should only be responsible for charges that are true, accurate, and reasonable.
Assent has developed a proprietary database (Assent MAX) that includes the hospital’s cost to charge ratios. Cost to charge ratio is based on the hospitals’ most recent cost of providing medical services which are reported to CMS (formally HCFA). Rather than pursuing discounts based on billed charges, Assent is utilizing its Cost-Up approach as a strategic arbitration tool when settling out of network claims. The Cost-Up approach allows Assent to use the hospitals’ own data to reach a fair, equitable, and transparent resolution to both the payer and provider.
All medical bills are reviewed by a medical physician over $50,000 which provides the best of financial, business practice and medical expertise resulting in…
- MAXimum Savings
- MAXimum Security
- MAXimum Transparency
- MAXimum Satisfaction
While each claim is unique, Assent’s financial cost-up and medical-based focus is successful in securing deep savings on medical bills.
A payer based in the western U.S., had an out-of area, out-of-network claim, in the Eastern U.S. The provider was located in New Jersey, notorious for its high costs and reluctance to negotiate.
The bill received was $247,722 for an emergency admission with convulsions. The primary diagnosis of bacterial meningitis resulted in a 14-day admission, and the primary procedure was a spinal tap.
Assent applied its proprietary formula to this claim, including a cost-up analysis, which indicated that the hospital was marking up its charges by more than 600 percent above the hospital’s publicly reported cost. The cost-up approach allowed Assent to use the hospital’s own data to reach a fair, equitable, and transparent resolution for both the payer and the provider. This claim was also reviewed by Assent’s medical physician, who identified via a line-by-line review more than $20,000 in charges challenges.
This combination of two strong defensible methods of review and analytics resulted in a 60 percent discount, where the provider accepted $100,000 as payment in full. The provider signed off on the settlement and the payment was made, saving the payer almost $150,000.
Call Re-Solutions today to find out more about Assent’s services.