NN&I - May 2010
Facility Management www.nephronline.comMarch 2010 Nephrology News & Issues 39 A more cost-effective alternativeIf the prospect of paying extreme-ly low amounts for dialysis services simply by hiring a repricer seemed too good to be true, that's because it was. For those plan holders and third-party administrators who chose this path, the portion of the savings that was not already kicked-back to the repricer may now go to defending the increasing number of claims brought by providers. In addition to the attor -neys' fees, the executives, managers, and employees of these plan holders and third-party administrators may face countless hours of testimony in depositions and courtroomsand not to mention hours of explaining to their boards of trustees and beneficia-ries why they chose to put their plan assets at risk in this manner. Surely the explanation will be that dialysis services are expensive and they were looking for a way to man-age the costs. And there is truth to that; dialysis is an expensive therapy. It is important to remember that patients on dialysis are receiving If the prospect of paying extremely low amounts for dialysis services simply by hiring a repricer seemed too good to be true, that's because it was. life-saving therapy for four to five hours three days a week from highly-skilled caregivers. Because of the reimbursement structure for dialysis under the Medicare program, these plans holders are only responsible for the costs of this treatment for a finite period of time (30 months). Nevertheless, working directly with the providers on a mutually accept -able rate for treatment is always an option. In addition to formal contract -ing, providers are often amenable to single-patient agreements that offer a discount from billed charges in exchange for certainty and predict -ability of timely payment. With such an arrangement, the plan holders or third-party administrators benefits in two major ways: they will enjoy the peace of mind that the rate is legiti- mate and they will not be subject to costly legal challenges. Facility Management_0510_3.indd 39 4/16/10 4:56:45 PM
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