Medical Cost Containment

Medical Cost Containment

If you are not using Future Care’s medical audit and cost containment services you likely are paying more than you should for your crew medical costs.

Future Care has been helping shipowners and their P&I Clubs significantly reduce the cost of hospitalization, emergency evacuation, out-patient rehabilitation, pharmacy and related medical treatment costs for almost 20 years. We accomplish this goal through specialized skills and services, including audit/forensic medical accounting; PPO network admission; PPO re-pricing; medical case management; utilization management; retrospective review and negotiation.

Our goal is to ensure that the shipowner and the P&I Club pay the most cost-effective price for the crewmember’s major medical treatment, and that all treatment charged was medically necessary and actually provided.

 

Audit/Forensic Medical Accounting

Medical audit/accounting is a specialized field of accounting, requiring knowledge of how hospitals, physicians and medical providers around the world calculate their fees for services rendered. In the United States, Future Care’s auditors begin by utilizing proprietary software programs to analyze CPT code compliance and appropriate fee structure.

In a number of countries in South America and the Caribbean Future Care has network access to preferred provider agreements and our auditing team reviews firstly for compliance with the agreed rating. In those locations without network access Future Care audits all medical charges for “usual and customary” pricing.

Future Care’s International audit team includes physicians, accountants and others in a number of locations with specialized knowledge of acceptable medical billing practice in the particular country or region where treatment is provided.

Future Care’s team of trained medical auditors understands how medical billing works, and keeps a sharp eye out for “unbundling” (billing separately for procedures customarily billed as one, at a lower cost) and other questionable or fraudulent practices.

Additionally Future Care medical auditors undertake a personal, line by line review of all charges, saving the shipowner from paying for services not provided or requested; duplicate or mispriced charges; overpricing and related errors otherwise inflating the bill.

Future Care’s medical auditing process is completely transparent to the client. Our team does not accept summary charges from middlemen and insists on original billing directly from the provider. All final recommendations for audit re-pricing to the shipowner and the Club include copies of the original invoices from the treatment providers.

Future Care medical auditors distinguish themselves through their specialized training and understanding of local medical billing practice, resulting in an unparalleled success rate in reducing costs. In the United States our audit team trains and works exclusively on maritime medical bill review and negotiation.

 

PPO Network Admission

In the United States and in a limited number of additional countries Future Care has established a network of Preferred Provider Organizations (PPO) which allows the shipowner and/or P&I Club access to discounted medical fee billing schedules. When Future Care is involved in the medical incident from inception, onboard ship, through our Caring for the Crew® program, we can steer the crewman to an appropriate network facility and in most instances secure these favorable fee schedules before or upon admission. In the United States Future Care’s access to PPO rates can result in a savings in excess of 50% or more for the shipowner and the Club.

This PPO access allows Future Care to obtain significantly reduced pricing upon treatment inception, without the necessity of protracted audit and/or post-discharge billing negotiations. There is no need for accountants, lawyers, arbitration, mediation, threats against the ship, etc. A shipowner’s access to reduced PPO rates is a matter of contract, not a right. The shipowner and/or P&I Club not taking advantage of Future Care’s PPO network access, when available, is incurring unnecessary and unpredictable post-discharge audits, where the outcome is uncertain and the treatment provider holds the upper hand.

 

PPO Re-Pricing

Future Care’s access to Preferred Provider Organizations (PPO) enables the shipowner and/or P&I Club to obtain, when available, the steeply discounted rates/fee schedules hospitals and other medical treatment providers accept from the large United States health insurers. Even if a shipowner has not yet enrolled in our Caring for the Crew® program Future Care can conduct a post-discharge audit and, where available, attempt to obtain PPO re-pricing.

In the United States access to PPO rates can result in the savings of 50% or more. Uninsured patients in the U.S. pay the highest rates for hospitalization and related medical services; the health insurers pay the least. A crewman without personal, U.S. health insurance is likely to be charged the highest rates. P&I insurance is not personal health insurance and the Clubs are not “health insurers”. Future Care’s independent network of PPO providers offers the shipowner and Club the greatest opportunity to favorably re-price post discharge medical bills at greatly reduced PPO rates, as if the crewman had the relevant personal health insurance.

 

Negotiation

Future Care’s team of specialized medical auditors understands how hospitals, physicians and medical providers around the world calculate their fees for services. With this understanding comes an ability to negotiate knowledgably and professionally with the hospital and/or physician billing department, whether located in Balboa or Bremerhaven, San Diego or Shanghai.

Future Care’s medical auditors manually review each line item on the treatment provider’s billing statement. Negotiation includes such benchmarks as the facility’s/physician’s compliance with compulsory or agreed rates; customary and usual and customary billing; provider cost basis; medical necessity and treatment “unbundling” among many other relevant medical and accounting issues.

PLEASE CONTACT US FOR PRICING INFORMATION FOR FUTURE CARE’S MEDICAL AUDIT AND COST CONTAINMENT PROGRAM OR ANY INDIVIDUAL SERVICE AT INFO@FUTURECAREINC.COM.

 

Please explore our other services, summarized on our Caring for the Crew® Program page.