Use of Chargemaster Rates in Balance Billing

This study reiterates our position on the use of hospital chargemaster rates in balance billing for out-of-network charges.

What is Balance Billing?

Balance Billing is a term used when an insured patient is responsible for the balance between what their insurance company is contracted to pay and what their physician or the facility wants to charge for a service.  Balance Billing often occurs when an insured patient receives treatment from an out-of-network physician at an in-network facility.  Read more

Medicare Overpays as Hospital Prices Rise

Medicare Overpays as Hospital Prices Rise

Soaring bills for sickest patients can throw payment formula out of whack Read more

Negotiations: Tenacity, Experience, and Data Leads to Success

Our tenacity, experience, and proprietary data all come together to provide fair and successful results for our clients in the negotiation process.

You may be wondering what is it that Chapman Consulting does differently to get results that are truly fair and defensible? Why are we so sure of our services?  What gives us an edge? Read more

Health Care Costs

Contracted Discounts Don’t Always Equate to Fair Payments

Contracted discounts don’t always equate to fair payments. Our medical bill review service provides a defensible means to fair charges.

Payors of medical claims are, of course, accustomed to paying their bills according to the rates or percent discount set forth in the contracts with facilities.  But with the rapid rise in hospital charges seen over the last five years or more, how does the payor KNOW the negotiated discount is a fair rate today? Read more

Does Your Bill Review Company Provide Reductions that Stick?

Does your bill review company provide medical bill reductions that stick?

Are their bill reductions defensible?  Substantiated?

Do they stand by their recommendations and strive for reasonableness for you?  Read more

Patients take frustrating, labyrinthine journey to uncover hospital costs

Patients experience a daunting task when trying to understand hospital charges.  Although high dollar hospital bills are seen all over the country, this article written by Mary Ann Roser with the Austin American-Statesman on July 21, 2012 points to the inflated hospital charges in the Austin, TX area particularly for the uninsured patient and how difficult it is to navigate and comparison shop due to the complexities of the system.  Read more

Inflated Medical Bills Mask True Cost of Healthcare in the U.S.

How can we get a real sense of the cost of healthcare in the U.S. when medical charges are so incredibly inflated?  These inflated charges mask the true cost of care.

And to make matters more confusing, the charges for a procedure for one patient can vary greatly depending on who is responsible for paying for that procedure.  Is the payor the patient? An insurance company? Medicare? Workers Compensation? Are the charges Out-of-Network?  Medical charges differ vastly depending on who the payor will be.

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Beware: Urgent Care Clinics May Charge Emergency Room Rates

Insist on knowing charges and billing practices before treatment at an Urgent Care Clinic.  Many patients are surprised when they are charged Emergency Room rates at these facilities.

The Urgent Care Association of America released a report in 2011 estimating there are 9000 urgent care clinics in the U.S. with 300 new centers opening each year.  Use of these clinics has gained in popularity due to many factors such as not requiring appointments, short wait times, open 7 days a week, offering a wide range of non-emergency non-life threatening services, and billed charges similar to a physician office visit.

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Time Article – Bitter Pill: Why Medical Bills Are Killing Us

Bitter Pill: Why Medical Bills Are Killing Us
By Steven Brill
Time Health & Family
February 20, 2013

Rarely do we see a health care related article cause such a stir. This well researched article written by Steven Brill is a must read. Colleagues sent us emails making sure we read it. Twitter, LinkedIn, and other social sites had thousands of reposts. And just after one week, many related articles and commentary have quickly been published based on Brill’s research and report. Of particular interest to all readers is the lack of transparency in hospital charges. But Brill’s research exposes the lack of relevance of the hospitals’ “Chargemaster”. Read more

Observation vs Inpatient: Maximizing Reimbursement for Hospital Stays

By Marc Chapman

The way work comp patients are classified as “observation” or “inpatient” can have an effect on the amount the hospital is reimbursed. We reviewed one claim that was classified and billed as an inpatient to a work comp carrier, where the patient was in the hospital a total of 4 hours.

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