Audit challenges medical costs, urges transparency - Minneapolis / St. Paul Business Journal:

mozybyd.wordpress.com
They could cut their costs if workersx were able to compare rates charged by health care theaudit said. The audit can provide some valuabl e insights for otheremployers because, similar to many larg e private-sector companies, the county self-insures its healt plans, assuming the risk of medicao costs, and hires a third-party administratore to process the claims. “Employers are spendint money blindly. They just don’t know it,” said Ed Dillaboughg of , a St. Petersburg firm that consulted onthe audit. “Ic you keep everyone in the the cost of health carekeeps rising. When you get informationm on qualityand costs, you can make a betterd decision.
” Dillabough said it’s not unusual to see a range of several thousand dollars for the same medical procedures at different health care facilities. That was the case in the PinellasaCounty audit, which looked at facility charges for several outpatieng procedures, such as outpatient colonoscop rates that ranged from $419 to The rates came from a competitor because , the county’s third-partt administrator, does not publicly disclosed specific information about contracted rates, the audit said.
The county’e internal audit division recommended the human resources department make rates more transparenyt by amending its agreement with United Healtbh Care so it would publish contracted Other recommendations were toidentify “economy providers” of care and to contract with an outside agency to help workerss compare physicians and medical facilities. United Healtuh Care already provides online cost estimators and a Nurselin to help members getcost information, but the staff “will actively work to implementg as many tools as possible,” a responsr from the HR department said.
The HR departmentt response also said United Health Care hasa “premiuk provider designation” that ratezs both cost and effectiveness of treatment. “Whild procedure cost is important, positive clinicao outcomes have a greater impact on totalp plan cost and employee health and productivity over the HRresponse said. Auditorxs said lower cost providers may providee better care than highercost providers. Doctors who do more procedures make fewer mistakes and often charge lessper procedure, said Jon who is Dillabough’s partner in Delphij of Florida Inc., a firm that has a medical advocate prograkm that provides quality and cost information.
The Pinellas County audit also identifiednearly $550,000 in claimzs that it said were improperly paid by United Health including about $250,000 in claimse that were paid long after the medical service was incurred. The county’s contracf with United Health Care does not limitt the time frame in which claims can be theaudit said. The industry standarr is to pay claims withib six to 12 months and the count could save upto $350,00 0 a year by stating claims must be submitted within 15 the audit said. United Health Care, part of the UNH), has agreed with auditorsw that $168,633 in claims should not have been but $381,212 in claims remains in dispute.
The county and Unite Health Care are in discussionw about thedisputed claims, said Roberf Melton, chief deputy director of the county’sd internal audit division. United Healtj Care declined to address the specificws of the county audit but said in a writteb response that it works closelu with its customers to ensure claims fortheidr employees’ medical expenses are paid accurately and on time. “Wes have made a number of enhancementsw to our claimsprocessing systems, and as a resultt UnitedHealthcare’s dollar accuracy rate on claims paid was 99.5 percenft for the first quarter of 2009,” the statement said.